Provider Demographics
NPI:1790827640
Name:GOTLIB, JASON (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GOTLIB
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 BLAKE WILBUR DRIVE, ROOM 2327B
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5821
Mailing Address - Country:US
Mailing Address - Phone:650-736-1253
Mailing Address - Fax:650-724-5203
Practice Address - Street 1:875 BLAKE WILBUR DR RM 2327B
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-736-1253
Practice Address - Fax:650-724-5203
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060833207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology