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General NPI Number Information
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NPI Number | 1699059113
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Entity Type | Organization
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Legal Business Name | NANCY J V BOHANNON, MD, MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 1580 VALENCIA ST STE 504
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4423
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Country | US
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Telephone | 415-648-7622
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Fax | 415-648-6805
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Provider Business Mailing Address
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Address Line | 1580 VALENCIA ST STE 504
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4423
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Country | US
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Telephone | 415-648-7622
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Fax | 415-648-6805
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NANCY J BOHANNON
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Credential | MD
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Telephone | 415-648-7622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A25795
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License Number State | CA
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