Healthcare Provider Details

I. General information

NPI: 1053316828
Provider Name (Legal Business Name): JAY STANLEY LUXENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

IV. Provider business mailing address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

V. Phone/Fax

Practice location:
  • Phone: 415-406-1416
  • Fax: 415-334-3091
Mailing address:
  • Phone: 415-406-1416
  • Fax: 415-334-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG43252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: