MEDICARE: DR. JAY STANLEY LUXENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	G43252	CA

General Provider Information

NPI Number	:	1053316828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY STANLEY LUXENBERG M.D.

Provider Business Mailing Address
First Line	:	302 SILVER AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1510
Country	:	US
Telephone Number	:	415-406-1416
Fax Number	:	415-334-3091

Provider Business Practice Location Address
First Line	:	302 SILVER AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1510
Country	:	US
Telephone Number	:	415-406-1416
Fax Number	:	415-334-3091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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