Healthcare Provider Details

I. General information

NPI: 1255435301
Provider Name (Legal Business Name): PAUL HARMATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND STREET
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3058
  • Fax: 510-450-5813
Mailing address:
  • Phone: 510-428-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG35255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: