Healthcare Provider Details

I. General information

NPI: 1700088069
Provider Name (Legal Business Name): MICHAEL ROBERT WATERFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF PEDIATRIC DEPARTMENT 505 PARNASSUS M-691
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

UCSF PEDIATRIC DEPARTMENT 505 PARNASSUS M-691
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5001
  • Fax:
Mailing address:
  • Phone: 415-476-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: