Provider Demographics
NPI:1225234099
Name:DOWNTOWN INTERNAL MEDICINE MEDICAL GROUP
Entity Type:Organization
Organization Name:DOWNTOWN INTERNAL MEDICINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-362-7177
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1723
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-362-7177
Mailing Address - Fax:415-362-8309
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1723
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-362-7177
Practice Address - Fax:415-362-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty