Healthcare Provider Details

I. General information

NPI: 1346153749
Provider Name (Legal Business Name): CHARLES HARRISON CLANTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 CAPP ST
SAN FRANCISCO CA
94110-1810
US

IV. Provider business mailing address

428 CAPP ST
SAN FRANCISCO CA
94110-1810
US

V. Phone/Fax

Practice location:
  • Phone: 415-412-7963
  • Fax:
Mailing address:
  • Phone: 415-412-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG36776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: