Provider Demographics
NPI:1417091505
Name:PRINCE, DAVID ALLAN (MD)
Entity Type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:ALLAN
Last Name:PRINCE
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 1:333 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7716
Mailing Address - Country:US
Mailing Address - Phone:650-723-5522
Mailing Address - Fax:650-723-1080
Practice Address - Street 1:300 PASTEUR DR.
Practice Address - Street 2:STANFORD UNIV. SCHOOL OF MEDICINE
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5122
Practice Address - Country:US
Practice Address - Phone:650-723-5522
Practice Address - Fax:650-723-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7803282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital