Provider Demographics
NPI:1871548271
Name:STAVOSKY, JAMES WILLIAM (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:STAVOSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5669
Mailing Address - Country:US
Mailing Address - Phone:650-348-8466
Mailing Address - Fax:
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-755-3338
Practice Address - Fax:650-755-7892
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4828010001Medicare NSC