Provider Demographics
NPI:1780240234
Name:JOW SPORTS MEDICINE PC
Entity type:Organization
Organization Name:JOW SPORTS MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-216-7771
Mailing Address - Street 1:425 2ND ST STE 307
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1420
Mailing Address - Country:US
Mailing Address - Phone:415-480-4569
Mailing Address - Fax:
Practice Address - Street 1:425 2ND ST STE 307
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1420
Practice Address - Country:US
Practice Address - Phone:415-480-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty