Provider Demographics
NPI:1649376211
Name:DOSSETT, DONALD RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RICHARD
Last Name:DOSSETT
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 1:2001 UNION ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4108
Mailing Address - Country:US
Mailing Address - Phone:415-447-6899
Mailing Address - Fax:415-447-6894
Practice Address - Street 1:455 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3635
Practice Address - Country:US
Practice Address - Phone:650-636-1286
Practice Address - Fax:650-588-4164
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ96273ZMedicare ID - Type UnspecifiedMEDICARE #