Provider Demographics
NPI:1740293406
Name:L.B. CARR MEDICAL GROUP
Entity type:Organization
Organization Name:L.B. CARR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-353-6153
Mailing Address - Street 1:PO BOX 281377
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94128-1377
Mailing Address - Country:US
Mailing Address - Phone:650-616-2948
Mailing Address - Fax:
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:ST FRANCIS HOSP PATH DEPT
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF1204207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085980Medicaid
CAZZZ16329ZMedicare ID - Type UnspecifiedMEDICARE GROUP #