David S Fankushen, M.D. Valid NPI

Individual provider · Internal Medicine Physician · San Rafael, CA

NPI

1174721856

Type

Individual (Type 1)

Primary specialty

Internal Medicine Physician (Internal Medicine)

Specialty group

Allopathic & Osteopathic Physicians

Taxonomy code

207R00000X

License number

GFE10777 (CA)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-07-05

Last updated

2007-07-08