1083678726 NPI number — MARTIN IRWIN BRONK MD

Table of content: MARTIN IRWIN BRONK MD (NPI 1083678726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083678726 NPI number — MARTIN IRWIN BRONK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRONK
Provider First Name:
MARTIN
Provider Middle Name:
IRWIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083678726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000 FILE 72484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-498-6500
Provider Business Mailing Address Fax Number:
650-322-1329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 CRANE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENLO PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-498-6500
Provider Business Practice Location Address Fax Number:
650-322-1329
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G42455 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MMM00087M . This is a "NHIC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com