Individual
DR. JONATHAN CARL BIXBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 PARNASSUS AVE, ROOM M-696, BOX 0110, SAN FRANCISCO, CA 94143-0110
(415) 502-2720
Mailing address
MISSION HALL, BOX 0110, 550 16TH STREET, 4TH FLOOR, SAN FRANCISCO, CA 94143-2549
(415) 502-2720
(415) 502-7516
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301092684
MI
208000000X
Pediatrics Physician
Primary
A127136
CA
2080S0010X
Pediatric Sports Medicine Physician
A127136
CA
208100000X
Physical Medicine & Rehabilitation Physician
4301092684
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301092684
STATE LISCENCE
MI
01
—
A127136
MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
08/19/2008
Last updated
07/10/2018
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