Healthcare Provider Details

I. General information

NPI: 1639277221
Provider Name (Legal Business Name): DOUGLAS WALTER ZUCKERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL DEPT OF CARDIOLOGY 2ND FLOOR
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

647 PENNSYLVANIA AVE
SAN FRANCISCO CA
94107-2915
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-3186
  • Fax:
Mailing address:
  • Phone: 917-539-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA103950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: