Provider Demographics
NPI:1669660205
Name:BRIAN E DEMUTH MD A PROFESSIONAL
Entity Type:Organization
Organization Name:BRIAN E DEMUTH MD A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-464-0184
Mailing Address - Street 1:1000 S ELISEO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2150
Mailing Address - Country:US
Mailing Address - Phone:415-464-0184
Mailing Address - Fax:415-464-0295
Practice Address - Street 1:1000 S ELISEO DR STE 101
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2150
Practice Address - Country:US
Practice Address - Phone:415-464-0184
Practice Address - Fax:415-464-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG602230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43852Medicare UPIN