Provider Demographics
NPI:1255387148
Name:SLY, DAVID J (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SLY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 1250
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1728
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22993207Q00000X
NE223207Q00000X
AZ008715207Q00000X
IA02882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA92635OtherWELLMARK BCBS IA
IA1504449Medicaid
NE42-1283849-12Medicaid
NE42-1283849-12Medicaid
IA92635OtherWELLMARK BCBS IA
IAI8179Medicare ID - Type Unspecified