Provider Demographics
NPI:1407109242
Name:EVAN R. RANSOM, MD, PC
Entity Type:Organization
Organization Name:EVAN R. RANSOM, MD, PC
Other - Org Name:SAN FRANCISCO CENTER FOR FACIAL PLASTIC RECONSTRUCTIVE & LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-550-1077
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-550-1077
Mailing Address - Fax:415-391-2895
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-550-1077
Practice Address - Fax:415-391-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117324261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA117324OtherCA MD LICENSE