Provider Demographics
NPI:1134256126
Name:BAGDORF, BEVERLY (NP)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:BAGDORF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 1M
Mailing Address - Street 2:GENERAL MEDICAL CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8494
Mailing Address - Fax:415-206-6115
Practice Address - Street 1:1001 POTRERO AVE # 1M
Practice Address - Street 2:GENERAL MEDICAL CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8494
Practice Address - Fax:415-206-6115
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN206859163WP2201X
CANPF10513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
984955OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
NPXUXUMedicare UPIN