MEDICARE: BETHANY ANN EUBANKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	L6878	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487610655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANN EUBANKS MD

Provider Business Mailing Address
First Line	:	3434 21ST ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 21ST ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2213
Country	:	US
Telephone Number	:	415-285-6666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/24/2013

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