Provider Demographics
NPI:1205037629
Name:BERSOT, THOMAS POINTDEXTER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:POINTDEXTER
Last Name:BERSOT
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 1:1650 OWENS STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2261
Mailing Address - Country:US
Mailing Address - Phone:415-734-2027
Mailing Address - Fax:415-355-0919
Practice Address - Street 1:1001 POTRERO AVENUE
Practice Address - Street 2:BLDG 30 RM 3501K
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-4615
Practice Address - Fax:415-476-4918
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26303207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G263030Medicaid
CA00G263030Medicaid
A42971Medicare UPIN