Healthcare Provider Details

I. General information

NPI: 1235109893
Provider Name (Legal Business Name): JEFFREY ALAN CARMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 MOWRY AVE STE 34
FREMONT CA
94538
US

IV. Provider business mailing address

2557 MOWRY AVE STE 34
FREMONT CA
94538
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-4111
  • Fax: 510-797-3320
Mailing address:
  • Phone: 510-797-4111
  • Fax: 510-797-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA22891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: