Provider Demographics
NPI:1831361047
Name:SEID, DERALD L (DO)
Entity type:Individual
Prefix:
First Name:DERALD
Middle Name:L
Last Name:SEID
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:SUITE # 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-221-1901
Mailing Address - Fax:415-221-1903
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:SUITE # 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1078
Practice Address - Country:US
Practice Address - Phone:415-221-1901
Practice Address - Fax:415-221-1903
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2015-05-11
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Provider Licenses
StateLicense IDTaxonomies
CA020A47840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08810Medicare UPIN
CACY858ZMedicare PIN