Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | G41447 | CA |
NPI | 1447211784 |
---|---|
Provider Name | Jeffrey Stern |
First Address | Berkeley, CA 94704-2608 |
Second Address | Berkeley, CA 94704-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A48575 | (02) | CA |