Provider Demographics
NPI:1912980012
Name:PROTSMAN, FAITH R (MD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:R
Last Name:PROTSMAN
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 1:700 W 6TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6014
Mailing Address - Country:US
Mailing Address - Phone:408-846-6444
Mailing Address - Fax:408-846-1067
Practice Address - Street 1:700 W 6TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6014
Practice Address - Country:US
Practice Address - Phone:408-846-6444
Practice Address - Fax:408-846-1067
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72923207RH0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G729231Medicaid
CA00G729231Medicaid
CA00G729230Medicare ID - Type UnspecifiedMEDICARE ID