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Dr. Jack William Osullivan, MD
Student in an Organized Health Care Education/Training Program in Palo Alto, California
NPI 1952930570

Jack William Osullivan is a Student in an Organized Health Care Education/Training Program based in Stanford, CA. Jack William Osullivan practices in Palo Alto, CA and has the professional credentials of MD. The NPI Number for Jack William Osullivan is 1952930570 and holds a License No. (California).

The current practice location address for Jack William Osullivan is 3801 Miranda Ave Uppr Va, Palo Alto, CA and can be reached out via phone at 650-493-5000.

Location: 3801 Miranda Ave Uppr Va, Palo Alto, CA, 94305-5133
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1952930570
Provider Name
Jack William Osullivan
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
3801 Miranda Ave Uppr Va, Palo Alto, CA, 94305-5133
Phone Number
650-493-5000
Fax Number
Provider Enumeration Date
04/06/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3801 Miranda Ave Uppr Va
City
Palo Alto
State
California
Zip
94304-1207
Phone Number
650-493-5000
Fax Number
person
Provider Business Mailing Address Details
Address
3801 Miranda Ave Uppr Va
City
Palo Alto
State
California
Zip
94304-1207
Phone Number
650-493-5000
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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