MEDICARE: JESSICA FOGLER WALDURA MD

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	207Q00000X	Family Medicine Physician	A73817	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080190993	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1760417398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FOGLER WALDURA MD

Provider Business Mailing Address
First Line	:	2866 25TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4262
Country	:	US
Telephone Number	:	415-282-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2866 25TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4262
Country	:	US
Telephone Number	:	415-282-2922
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/01/2015

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