Provider Demographics
NPI:1356415095
Name:SCHOFFERMAN, LESSLIE (MD)
Entity type:Individual
Prefix:DR
First Name:LESSLIE
Middle Name:
Last Name:SCHOFFERMAN
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 1:175 N REDWOOD DR
Mailing Address - Street 2:STE 275
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1942
Mailing Address - Country:US
Mailing Address - Phone:415-331-8390
Mailing Address - Fax:415-331-8380
Practice Address - Street 1:ONE DANIEL BURNHAM CT
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-331-8390
Practice Address - Fax:415-331-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573140Medicare ID - Type Unspecified
CAA53264Medicare UPIN