Basic Information
| Provider Information | |||||||||
| NPI: | 1164737318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRATMAN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | VICTOR | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 BLAKE WILBUR DRIVE | ||||||||
| Address2: | STANFORD CANCER CENTER | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236171 | ||||||||
| FaxNumber: | 6507258231 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 BLAKE WILBUR DRIVE | ||||||||
| Address2: | STANFORD CANCER CENTER | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236171 | ||||||||
| FaxNumber: | 6507258231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | A113507 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.