Provider Demographics
NPI:1942356233
Name:LETZ, GIDEON ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:ALBERT
Last Name:LETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 MARKET ST
Mailing Address - Street 2:RM. 1400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1410
Mailing Address - Country:US
Mailing Address - Phone:415-565-1677
Mailing Address - Fax:415-581-8044
Practice Address - Street 1:1275 MARKET ST
Practice Address - Street 2:RM. 1400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1410
Practice Address - Country:US
Practice Address - Phone:415-565-1677
Practice Address - Fax:415-581-8044
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG355032083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M193827OtherNUID