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General NPI Number Information
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NPI Number | 1053451518
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Entity Type | Individual
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Provider Name | JORDAN C DESCHAMPS-BRALY MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 360 POST ST STE 901
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4988
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Country | US
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Telephone | 415-624-3922
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Fax |
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Provider Business Mailing Address
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Address Line | 360 POST ST STE 901
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4988
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Country | US
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Telephone | 415-624-3922
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Fax | 415-276-9382
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A-121399
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A121399
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24625
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License Number State | OK
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