MEDICARE: DR. PHILIP EMANUEL LEBOIT 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	207ZD0900X	Dermatopathology (Pathology) Physician	G43513	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G435130	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1154385938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP EMANUEL LEBOIT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10076
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91410-0076
Country	:	US
Telephone Number	:	805-578-8300
Fax Number	:	805-578-8950

Provider Business Practice Location Address
First Line	:	1701 DIVISADERO ST
Second Line	:	SUITE 335
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3011
Country	:	US
Telephone Number	:	415-353-7546
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/08/2007

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