Provider Demographics
NPI:1952340176
Name:PERTSCH, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:PERTSCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 ST.MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2807
Mailing Address - Country:US
Mailing Address - Phone:650-344-8700
Mailing Address - Fax:650-344-8187
Practice Address - Street 1:104 ST.MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2807
Practice Address - Country:US
Practice Address - Phone:650-344-8700
Practice Address - Fax:650-344-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG62677208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89328Medicare UPIN
CA00G626770Medicare PIN