Provider Demographics
NPI:1528125135
Name:EKSTRAND, BRADLEY CAMERON (MD, PHD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CAMERON
Last Name:EKSTRAND
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3913
Mailing Address - Country:US
Mailing Address - Phone:650-341-9131
Mailing Address - Fax:650-341-9135
Practice Address - Street 1:218 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3913
Practice Address - Country:US
Practice Address - Phone:650-341-9131
Practice Address - Fax:650-341-9135
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71243207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A712431Medicare PIN
CAH65777Medicare UPIN