Provider Demographics
NPI:1801880398
Name:TAPPAN, JAMES GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:TAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20 W 3RD AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-7112
Mailing Address - Country:US
Mailing Address - Phone:650-347-5065
Mailing Address - Fax:650-348-3425
Practice Address - Street 1:20 W 3RD AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-7112
Practice Address - Country:US
Practice Address - Phone:650-347-5065
Practice Address - Fax:650-348-3425
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23884207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063440Medicaid
94-3061735OtherFEDERAL TAX ID
CAA23884OtherMEDICAL LICENSE
05D078482OtherCLIA
AT6157160OtherDEA REGISTRATION
CAA23884OtherMEDICAL LICENSE
A23743Medicare UPIN