Provider Demographics
NPI:1780790378
Name:GOSSETT, JEFFREY GALE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GALE
Last Name:GOSSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 16TH ST, 5TH FLOOR
Mailing Address - Street 2:BOX 0544
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-2719
Mailing Address - Fax:415-353-4144
Practice Address - Street 1:550 16TH ST FL 5
Practice Address - Street 2:BOX 0544
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2549
Practice Address - Country:US
Practice Address - Phone:415-476-2719
Practice Address - Fax:415-353-4144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC1448492080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18993Medicare UPIN
H18993Medicare UPIN
IL036115835Medicare ID - Type Unspecified