Basic Information
| Provider Information | |||||||||
| NPI: | 1235443292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHEN J. WHITGOB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 TELEGRAPH AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052018 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2900 TELEGRAPH AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108839883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2010 | ||||||||
| LastUpdateDate: | 08/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | WHITGOB | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4158839883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G024893 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.