Individual
REED COAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
750 LAS GALLINAS AVE STE 115, SAN RAFAEL, CA 94903-3431
(415) 472-5595
Mailing address
2299 POST ST STE 205, SAN FRANCISCO, CA 94115-3473
(208) 691-0809
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5597
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
EL6799
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2016
Last updated
11/16/2020
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