Provider Demographics
NPI:1134170467
Name:SAFRAN, MARC RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:RAYMOND
Last Name:SAFRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:EDWARDS R105
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-725-9323
Mailing Address - Fax:650-498-7186
Practice Address - Street 1:1000 WELCH RD
Practice Address - Street 2:STE 100, MC 5357
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1811
Practice Address - Country:US
Practice Address - Phone:650-723-5643
Practice Address - Fax:650-723-6056
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45656207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456560Medicaid
CAF79435Medicare UPIN
CA00A456560Medicaid