Provider Demographics
NPI:1811177439
Name:PERSHING, SUZANN (MD)
Entity type:Individual
Prefix:
First Name:SUZANN
Middle Name:
Last Name:PERSHING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:ROOM A157 MC 5308
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-6995
Mailing Address - Fax:650-723-7918
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:ROOM A157 MC 5308
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-6995
Practice Address - Fax:650-723-7918
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101067207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13678Medicare UPIN