MEDICARE: DR. JOHN ANTHONY SELLE D.O.

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	207R00000X	Internal Medicine Physician	20A8681	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518950351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY SELLE D.O.

Provider Business Mailing Address
First Line	:	2250 HAYES ST
Second Line	:	SUITE 206
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1078
Country	:	US
Telephone Number	:	415-379-6100
Fax Number	:	415-379-6200

Provider Business Practice Location Address
First Line	:	2250 HAYES ST
Second Line	:	SUITE 206
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1078
Country	:	US
Telephone Number	:	415-379-6100
Fax Number	:	415-379-6200

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/03/2008

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Directions to “ DR. JOHN ANTHONY SELLE D.O.” Practice Location

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