Provider Demographics
NPI:1518950351
Name:SELLE, JOHN ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:SELLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-379-6100
Mailing Address - Fax:415-379-6200
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1078
Practice Address - Country:US
Practice Address - Phone:415-379-6100
Practice Address - Fax:415-379-6200
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX86811Medicaid
CAI20705Medicare UPIN
CA00AX86811Medicaid