Provider Demographics
NPI:1083632582
Name:HERBSMAN, ODED (MD)
Entity Type:Individual
Prefix:DR
First Name:ODED
Middle Name:
Last Name:HERBSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2310
Mailing Address - Country:US
Mailing Address - Phone:415-732-7029
Mailing Address - Fax:415-732-7030
Practice Address - Street 1:990 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2310
Practice Address - Country:US
Practice Address - Phone:415-732-7029
Practice Address - Fax:415-732-7030
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532800Medicare PIN
CAG07580Medicare UPIN