Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A69332 | CA |
NPI | 1053495226 |
---|---|
Provider Name | Scott Jeffrey Standage |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H69023 | (02) | CA |