Healthcare Provider Details

I. General information

NPI: 1831373919
Provider Name (Legal Business Name): RICHARD G GLOGAU M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVENUE SUITE 400
SAN FRANCSICO CA
94117-3608
US

IV. Provider business mailing address

350 PARNASSUS AVENUE SUITE 400
SAN FRANCSICO CA
94117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-1261
  • Fax: 415-564-1967
Mailing address:
  • Phone: 415-564-1261
  • Fax: 415-564-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG28282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: