Provider Demographics
NPI:1174528889
Name:CARDNEAU, JEFFRY D (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:D
Last Name:CARDNEAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:99 MONTECILLO RD
Mailing Address - Street 2:MOB 1, 2ND FLOOR DEPARTMENT OF SURGERY
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3308
Mailing Address - Country:US
Mailing Address - Phone:415-444-2197
Mailing Address - Fax:
Practice Address - Street 1:99 MONTECILLO RD
Practice Address - Street 2:MOB 1, 2ND FLOOR, DEPARTMENT OF SURGERY
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3308
Practice Address - Country:US
Practice Address - Phone:415-444-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR249442086S0129X
CAA773132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022711Medicare ID - Type Unspecified
OR119815Medicare ID - Type Unspecified
ORH57740Medicare UPIN