Provider Demographics
NPI:1972515971
Name:VERCOUTERE, ANN L (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:VERCOUTERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1363 S ELISEO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2012
Mailing Address - Country:US
Mailing Address - Phone:415-461-2426
Mailing Address - Fax:415-461-2145
Practice Address - Street 1:1363 S ELISEO DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2012
Practice Address - Country:US
Practice Address - Phone:415-461-2426
Practice Address - Fax:415-461-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0426010208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery