Basic Information
| Provider Information | |||||||||
| NPI: | 1427468560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANFORD OB/GYN RESIDENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 LAKE WELDONA DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075807578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 PASTEUR DRIVE, ROOM HC435 | ||||||||
| Address2: | STANFORD DEPARTMENT OF GRADUATE MEDICAL EDUCATION | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504987570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 04/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | DRUZIN | ||||||||
| AuthorizedOfficialFirstName: | MAURICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6504987570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.