Provider Demographics
NPI:1790962546
Name:STINSON, EDWARD BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRAD
Last Name:STINSON
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 1:26444 TAAFFE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-4427
Mailing Address - Country:US
Mailing Address - Phone:650-941-6478
Mailing Address - Fax:
Practice Address - Street 1:26444 TAAFFE RD
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94022-4427
Practice Address - Country:US
Practice Address - Phone:650-941-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14152208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP4310ZMedicare PIN
CAA39181Medicare UPIN