Healthcare Provider Details

I. General information

NPI: 1508938887
Provider Name (Legal Business Name): BARRY DAVID ZEVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LECH WALESA
SAN FRANCISCO CA
94102-4506
US

IV. Provider business mailing address

50 LECH WALESA
SAN FRANCISCO CA
94102-4506
US

V. Phone/Fax

Practice location:
  • Phone: 415-355-7400
  • Fax: 415-355-7407
Mailing address:
  • Phone: 415-355-7400
  • Fax: 415-355-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG71721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG71721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: