Provider Demographics
NPI:1619921574
Name:WEISMAN, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:WEISMAN
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 1:515 SOUTH DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4204
Mailing Address - Country:US
Mailing Address - Phone:650-962-1100
Mailing Address - Fax:650-887-3380
Practice Address - Street 1:515 SOUTH DR
Practice Address - Street 2:SUITE 12
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4204
Practice Address - Country:US
Practice Address - Phone:650-962-1100
Practice Address - Fax:650-887-3380
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57035207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53222Medicare UPIN
CAZZZ30093ZMedicare ID - Type UnspecifiedHOLLISTER LOCATION
CAZZZ24164ZMedicare ID - Type UnspecifiedPALO ALTO LOCATION