Provider Demographics
NPI:1376670976
Name:MATHES, ERIN FORD-DIRKS (ERIN MATHES)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:FORD-DIRKS
Last Name:MATHES
Suffix:
Gender:F
Credentials:ERIN MATHES
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:FORD-DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 DIVISADERO ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0316
Mailing Address - Country:US
Mailing Address - Phone:415-353-7800
Mailing Address - Fax:415-353-7870
Practice Address - Street 1:1701 DIVISADERO ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0316
Practice Address - Country:US
Practice Address - Phone:415-353-7800
Practice Address - Fax:415-353-7870
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94786207N00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN