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General NPI Number Information
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NPI Number | 1316145469
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Entity Type | Organization
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Legal Business Name | FIRST MED MARIN MEDICAL CLINIC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 900 S ELISEO DR STE 202
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City | GREENBRAE
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State | CA
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Zip | 94904-2153
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Country | US
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Telephone | 415-461-3500
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Fax | 415-461-3891
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Provider Business Mailing Address
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Address Line | 900 S ELISEO DR STE 202
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City | GREENBRAE
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State | CA
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Zip | 94904-2153
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Country | US
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Telephone | 415-461-3500
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Fax | 415-461-3891
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Authorized Official
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Title or Position | PRES
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Name | DR. BARRY SANDFORD LANDFIELD
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Credential | MD
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Telephone | 415-461-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G19884
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License Number State | CA
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