| Denise Provost, MD | |
|
795 El Camino Real, Palo Alto, CA 94301-2302 | |
| (650) 853-2398 | |
| Not Available |
| Full Name | Denise Provost |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 795 El Camino Real, Palo Alto, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780789990 | NPI | - | NPPES |
| 00A810160 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A81016 (California) | Primary |
| Entity Name | Sutter Bay Medical Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013950807 PECOS PAC ID: 4284538778 Enrollment ID: O20031125000909 |
| Mailing Address | Practice Location Address |
|---|---|
| Denise Provost, MD 325 Distel Cir, Los Altos, CA 94022-1408 Ph: (650) 853-2970 | Denise Provost, MD 795 El Camino Real, Palo Alto, CA 94301-2302 Ph: (650) 853-2398 |
Dr. Ian J Nelligan, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 211 Quarry Rd, Palo Alto, CA 94304 Phone: 650-498-5409 | |
Sherry Huang, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-853-2984 | |
Mary Hufty, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-321-4121 | |
Tami Miller, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-321-4121 | |
Dr. Diana Chen, MD, MBA Family Medicine Medicare: Medicare Enrolled Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-321-4121 | |
Enrique Riddle, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-853-3355 | |
Jay Schlumpberger, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 795 El Camino Real, Palo Alto, CA 94301 Phone: 650-321-4121 |