Healthcare Provider Details

I. General information

NPI: 1174589527
Provider Name (Legal Business Name): JASON MCLAIN BLYTHE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 MISSION ST STE 327
SAN FRANCISCO CA
94110-2463
US

IV. Provider business mailing address

2480 MISSION ST #327
SAN FRANCISCO CA
94110-2468
US

V. Phone/Fax

Practice location:
  • Phone: 415-824-3737
  • Fax:
Mailing address:
  • Phone: 415-824-3737
  • Fax: 415-824-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number4637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: