Healthcare Provider Details

I. General information

NPI: 1417102633
Provider Name (Legal Business Name): JORDAN ANDREW CHASE M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE # WARD83 SFGH DEPT OF FAMILY AND COMMUNITY MEDICINE
SAN FRANCISCO CA
94110-2859
US

IV. Provider business mailing address

995 POTRERO AVE # WARD83 SFGH DEPT OF FAMILY AND COMMUNITY MEDICINE
SAN FRANCISCO CA
94110-2859
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5252
  • Fax: 415-206-8387
Mailing address:
  • Phone: 415-206-5252
  • Fax: 415-206-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: