Healthcare Provider Details

I. General information

NPI: 1386744779
Provider Name (Legal Business Name): DESMOND ERASMUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MOWRY AVENUE #222
FREMONT CA
94538-1605
US

IV. Provider business mailing address

2500 MOWRY AVENUE #222
FREMONT CA
94538-1605
US

V. Phone/Fax

Practice location:
  • Phone: 510-818-1160
  • Fax: 510-818-1195
Mailing address:
  • Phone: 510-818-1160
  • Fax: 510-818-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA34539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: