Provider Demographics
NPI:1144304130
Name:BRABANT, ENOCH C (MD)
Entity type:Individual
Prefix:DR
First Name:ENOCH
Middle Name:C
Last Name:BRABANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 CESAR CHAVEZ # ER
Mailing Address - Street 2:ST LUKE'S HOSPITAL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4403
Mailing Address - Country:US
Mailing Address - Phone:415-641-6625
Mailing Address - Fax:
Practice Address - Street 1:3555 CESAR CHAVEZ # ER
Practice Address - Street 2:ST LUKE'S HOSPITAL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4403
Practice Address - Country:US
Practice Address - Phone:415-641-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C421790Medicaid
CA00C421790Medicaid
00C421790Medicare ID - Type Unspecified