Provider Demographics
NPI:1770553950
Name:DEMUTH, BRIAN E (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:DEMUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 HAMILTON LNDG
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-8256
Mailing Address - Country:US
Mailing Address - Phone:415-884-1840
Mailing Address - Fax:415-883-7127
Practice Address - Street 1:1260 S ELISEO DR
Practice Address - Street 2:FLOOR 2
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2009
Practice Address - Country:US
Practice Address - Phone:415-461-7800
Practice Address - Fax:415-461-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G602230Medicare ID - Type Unspecified
D43852Medicare UPIN