Healthcare Provider Details

I. General information

NPI: 1346310539
Provider Name (Legal Business Name): ALLAN H RAPPAPORT M.D., J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MAIN ST
TIBURON CA
94920-2507
US

IV. Provider business mailing address

PO BOX 156
TIBURON CA
94920-0156
US

V. Phone/Fax

Practice location:
  • Phone: 415-435-4591
  • Fax: 415-435-4591
Mailing address:
  • Phone: 415-435-4591
  • Fax: 415-435-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberCR5189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: