Provider Demographics
NPI:1679661656
Name:GOLDEN GATE ENDOCRINE SPECIALISTS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:GOLDEN GATE ENDOCRINE SPECIALISTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-668-6767
Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:SUITE 578
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-668-6767
Mailing Address - Fax:415-668-8248
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:SUITE 578
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-668-6767
Practice Address - Fax:415-668-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G666990Medicare ID - Type Unspecified