Healthcare Provider Details

I. General information

NPI: 1255507489
Provider Name (Legal Business Name): ROWAN VICTOR PAUL M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 416
SAN FRANCISCO CA
94115-2379
US

IV. Provider business mailing address

2248 PARK BLVD
PALO ALTO CA
94306-1532
US

V. Phone/Fax

Practice location:
  • Phone: 650-328-4411
  • Fax:
Mailing address:
  • Phone: 650-328-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA99977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: