Provider Demographics
NPI:1932173291
Name:DANFORTH, MICHAEL SEAN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:DANFORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 CUSHING RD 624
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6173
Mailing Address - Country:US
Mailing Address - Phone:619-524-1309
Mailing Address - Fax:
Practice Address - Street 1:BRANCH MEDICAL CLINIC
Practice Address - Street 2:NAS NORTH ISLAND BOX 357046
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7046
Practice Address - Country:US
Practice Address - Phone:619-545-4263
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN