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General NPI Number Information
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NPI Number | 1720265937
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Entity Type | Organization
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Legal Business Name | PETER A VON ROGOV MDA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 2100 WEBSTER ST STE 300
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-749-5743
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Fax | 415-673-4971
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Provider Business Mailing Address
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Address Line | 2100 WEBSTER ST STE 300
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-749-5743
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Fax | 415-673-4971
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER A VON ROGOV
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Credential | MD
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Telephone | 415-749-5743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A23061
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License Number State | CA
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