MEDICARE: MARY ANN MINER 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	207V00000X	Obstetrics & Gynecology Physician	G46316	CA

General Provider Information

NPI Number	:	1942359625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN MINER M.D.

Provider Business Mailing Address
First Line	:	4877 MISSION ST
Second Line	:	4877 MISSION ST.
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-3413
Country	:	US
Telephone Number	:	415-405-0222
Fax Number	:	415-405-0223

Provider Business Practice Location Address
First Line	:	256 BAY VISTA CIR
Second Line	:
City	:	SAUSALITO
State	:	CA
Zip	:	94965-1037
Country	:	US
Telephone Number	:	415-887-9903
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	04/07/2011

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