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General NPI Number Information
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NPI Number | 1669660205
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Entity Type | Organization
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Legal Business Name | BRIAN E DEMUTH MD A PROFESSIONAL
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1000 S ELISEO DR STE 101
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City | GREENBRAE
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State | CA
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Zip | 94904-2150
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Country | US
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Telephone | 415-464-0184
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Fax | 415-464-0295
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Provider Business Mailing Address
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Address Line | 1000 S ELISEO DR STE 101
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City | GREENBRAE
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State | CA
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Zip | 94904-2150
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Country | US
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Telephone | 415-464-0184
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Fax | 415-464-0295
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BRIAN E. DEMUTH
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Credential | MD
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Telephone | 415-464-0184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G602230
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License Number State | CA
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