Individual
JOHN BASKERVILLE IMBODEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 POTRERO AVENUE, BLDG 30 RM 3300, SAN FRANCISCO, CA 94110-3518
(415) 206-5438
(415) 648-8425
Mailing address
PO BOX 7464, SAN FRANCISCO, CA 94120-7464
(415) 206-3103
(415) 206-3872
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G44969
CA
207RR0500X
Rheumatology Physician
Primary
G44969
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G449690
—
CA
Enumeration date
01/29/2007
Last updated
01/17/2012
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