Provider Demographics
NPI:1326073354
Name:CHOATE, JENNIFER J (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:CHOATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3035 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2204
Mailing Address - Country:US
Mailing Address - Phone:831-462-8755
Mailing Address - Fax:831-475-5713
Practice Address - Street 1:3035 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2204
Practice Address - Country:US
Practice Address - Phone:831-462-8755
Practice Address - Fax:831-475-5713
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59117207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G591170Medicare ID - Type Unspecified
D15905Medicare UPIN