Provider Demographics
NPI:1811099435
Name:TEARSE, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:TEARSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1391 WOODSIDE RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3574
Mailing Address - Country:US
Mailing Address - Phone:650-368-3937
Mailing Address - Fax:650-368-0270
Practice Address - Street 1:1391 WOODSIDE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3574
Practice Address - Country:US
Practice Address - Phone:650-368-3937
Practice Address - Fax:650-368-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42953207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429531Medicaid
180009109OtherRRM PIN
A42953OtherSTATE LICENSE
DC7365OtherRRM GROUP
CAZZZ09989ZOtherBLUE SHIELD GROUP
CAZZZ21710ZMedicare ID - Type UnspecifiedMEDICARE GROUP
CA00A429531Medicaid
CA00A429530Medicare ID - Type Unspecified