Healthcare Provider Details

I. General information

NPI: 1215935630
Provider Name (Legal Business Name): JOAN SUSAN DORFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MARKET ST SUITE 300
SAN FRANCISCO CA
94105-2854
US

IV. Provider business mailing address

1305 HENRY ST
BERKELEY CA
94709-1992
US

V. Phone/Fax

Practice location:
  • Phone: 415-904-9676
  • Fax:
Mailing address:
  • Phone: 510-527-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG021476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: