Provider Demographics
NPI:1982667846
Name:MISFELDT, DAYTON STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAYTON
Middle Name:STANLEY
Last Name:MISFELDT
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 1:725 E SANTA CLARA ST
Mailing Address - Street 2:#304
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1900
Mailing Address - Country:US
Mailing Address - Phone:408-930-5900
Mailing Address - Fax:408-938-5902
Practice Address - Street 1:725 E SANTA CLARA ST
Practice Address - Street 2:#304
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1900
Practice Address - Country:US
Practice Address - Phone:408-930-5900
Practice Address - Fax:408-938-5902
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20282174400000X
CODR.57413207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40885Medicare UPIN
CA00G202820Medicare ID - Type UnspecifiedPROVIDER #