Healthcare Provider Details

I. General information

NPI: 1538114004
Provider Name (Legal Business Name): REID FISHER BRACKIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HYDE STREET
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

PO BOX 660640
ARCADIA CA
91066-0640
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-6300
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA87762
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA87762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: