Healthcare Provider Details

I. General information

NPI: 1689633638
Provider Name (Legal Business Name): DONALD CALVIN FLETCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 CLAY ST # 514
SAN FRANCISCO CA
94115-1932
US

IV. Provider business mailing address

250 W DOUGLAS AVE APT 2516
WICHITA KS
67202-3119
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3901
  • Fax: 415-600-3949
Mailing address:
  • Phone: 650-346-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number04-33631
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number10260037-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0052066
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG56961
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-33631
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: