MEDICARE: DR. JEFFREY GALE GOSSETT M.D.

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	2080P0202X	Pediatric Cardiology Physician	C144849	CA

General Provider Information

NPI Number	:	1780790378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY GALE GOSSETT M.D.

Provider Business Mailing Address
First Line	:	550 16TH ST, 5TH FLOOR
Second Line	:	BOX 0544
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143
Country	:	US
Telephone Number	:	415-476-2719
Fax Number	:	415-353-4144

Provider Business Practice Location Address
First Line	:	550 16TH ST FL 5
Second Line	:	BOX 0544
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2549
Country	:	US
Telephone Number	:	415-476-2719
Fax Number	:	415-353-4144

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/02/2017

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