Provider Demographics
NPI:1548255482
Name:SUGARMAN, JEFFREY LOUIS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LOUIS
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-573-6918
Practice Address - Street 1:2725 MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2805
Practice Address - Country:US
Practice Address - Phone:707-545-4537
Practice Address - Fax:707-545-6726
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85304207NP0225X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548255482Medicaid
CA00G853040Medicaid
CAP01774457OtherRAILROAD MEDICARE
CACA232497Medicare PIN
CAP01774457OtherRAILROAD MEDICARE
CA00G853040Medicaid