MEDICARE: DERALD L SEID D O A MEDICAL CORPORATION

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	20A4784	CA

General Provider Information

NPI Number	:	1760466577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERALD L SEID D O A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2250 HAYES ST
Second Line	:	SUITE 500
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1078
Country	:	US
Telephone Number	:	415-221-1901
Fax Number	:	415-221-1903

Provider Business Practice Location Address
First Line	:	2250 HAYES ST
Second Line	:	SUITE 500
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1078
Country	:	US
Telephone Number	:	415-221-1901
Fax Number	:	415-221-1903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DERALD L SEID
Credential	:	DO
Telephone Number	:	415-221-1901

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/02/2015

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