Basic Information
Provider Information
NPI: 1932139417
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWEET
FirstName: RICHARD
MiddleName: MARK
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7464
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941207464
CountryCode: US
TelephoneNumber: 4152063103
FaxNumber: 4152063872
Practice Location
Address1: 1001 POTRERO AVENUE
Address2: BLDG 100 RM 350
City: SAN FRANCISCO
State: CA
PostalCode: 941103518
CountryCode: US
TelephoneNumber: 4154764617
FaxNumber: 4152828182
Other Information
ProviderEnumerationDate: 07/03/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XCFE35368CAX Allopathic & Osteopathic PhysiciansInternal Medicine 
207RN0300XCFE35368CAX Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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