Provider Demographics
NPI:1326087750
Name:BROCK-UTNE, ARNE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ARNE
Middle Name:JOHN
Last Name:BROCK-UTNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR RM H350
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:925-543-0140
Mailing Address - Fax:
Practice Address - Street 1:2420 CAMINO RAMON STE 270
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4319
Practice Address - Country:US
Practice Address - Phone:925-543-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72943207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729430Medicaid
00A729430Medicare ID - Type Unspecified
H83036Medicare UPIN