Jann, Bradley Glenn

Jann, Bradley Glenn is an sole proprietor health care provider with primary practice located at 100 Thorndale Dr Medical Clinic, San Rafael CA 94903-4501. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Jann, Bradley Glenn can be contacted via phone (415) 461-5995.

Contact Information

Primary practice address
100 Thorndale Dr Medical Clinic San Rafael CA 94903-4501
Phone: (415) 461-5995
Fax: (415) 461-5995
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X E3865 California

Profile Details

NPI number 1265429310
LBN Legal business name Jann, Bradley Glenn
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2005
Last updated Jul 25th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265429310 NPPES
California MEDICAID 000E38650

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