Provider Demographics
NPI:1326126863
Name:MACHO, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:MACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2107 OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3419
Mailing Address - Country:US
Mailing Address - Phone:415-775-2795
Mailing Address - Fax:415-829-7632
Practice Address - Street 1:2107 OFARRELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3419
Practice Address - Country:US
Practice Address - Phone:415-775-2795
Practice Address - Fax:415-829-7632
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-50396Medicare UPIN
CA00G464690Medicare ID - Type Unspecified