MEDICARE: DR. JEROME A. BARAKOS 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	2085R0202X	Diagnostic Radiology Physician	G63097	CA
2	2085N0700X	Neuroradiology Physician	G63097	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300130264	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	:	1972558922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME A. BARAKOS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6102
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94948-6102
Country	:	US
Telephone Number	:	415-884-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 VAN NESS AVE FL 3
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-6919
Country	:	US
Telephone Number	:	415-600-3232
Fax Number	:	415-447-6335

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/21/2024

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