Provider Demographics
NPI:1760466577
Name:DERALD L SEID D O A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DERALD L SEID D O A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-221-1901
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-221-1901
Mailing Address - Fax:415-221-1903
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1078
Practice Address - Country:US
Practice Address - Phone:415-221-1901
Practice Address - Fax:415-221-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4784207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08810Medicare UPIN
CACY857AMedicare PIN