Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 229914 | MA |
N | 111NI0900X | Internist | 229914 | MA |
N | 207R00000X | Internist | C55432 | CA |
N | 111NI0900X | Internist | C55432 | CA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | C55432 | CA |
NPI | 1013027424 |
---|---|
Provider Name | Justin P Annes |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 24/11/2021 |