Basic Information
| Provider Information | |||||||||
| NPI: | 1609189687 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANFORD UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 BLAKE WILBUR DRIVE | ||||||||
| Address2: | |||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055847 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 875 BLAKE WILBUR DRIVE | ||||||||
| Address2: | |||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236171 | ||||||||
| FaxNumber: | 6507258231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2010 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | GIBBS | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF EDUCATION | ||||||||
| AuthorizedOfficialTelephone: | 6507251723 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.