Provider Demographics
NPI:1285766212
Name:STAMOS, BASIL P (MD)
Entity type:Individual
Prefix:DR
First Name:BASIL
Middle Name:P
Last Name:STAMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 LECH WALESA
Mailing Address - Street 2:TOM WADDELL CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4506
Mailing Address - Country:US
Mailing Address - Phone:415-355-7400
Mailing Address - Fax:415-355-7407
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:TOM WADDELL CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7400
Practice Address - Fax:415-355-7407
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73877207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
018044OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
F14128Medicare UPIN