Healthcare Provider Details

I. General information

NPI: 1932296985
Provider Name (Legal Business Name): DAVID E. AVRIN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE BOX 0628
SAN FRANCISCO CA
94143-0628
US

IV. Provider business mailing address

505 PARNASSUS AVE BOX 0628
SAN FRANCISCO CA
94143-0628
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2573
  • Fax: 415-353-9488
Mailing address:
  • Phone: 415-353-2573
  • Fax: 415-353-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number5119518-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number5119518-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: