Basic Information
| Provider Information | |||||||||
| NPI: | 1497885487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS AFFAIRS PALO ALTO HEALTH CARE SYSTEMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 MIRANDA AVE | ||||||||
| Address2: | B101, B4-145 MC 154B | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
| FaxNumber: | 6508583986 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 MIRANDA AVE | ||||||||
| Address2: | B101, B4-145 MC 154B | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
| FaxNumber: | 6508583986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUTCHER | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PROFESSOR OF PATHOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 6504935000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 207ZI0100X | CA | Y | Hospitals | Military Hospital |
No ID Information.