Healthcare Provider Details

I. General information

NPI: 1356457881
Provider Name (Legal Business Name): PAUL A. VOLBERDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST VAMC 111
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

4150 CLEMENT ST VAMC 111
SAN FRANCISCO CA
94121-1545
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-2037
  • Fax: 415-750-2182
Mailing address:
  • Phone: 415-750-2037
  • Fax: 415-750-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG36568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: