Provider Demographics
NPI:1225384456
Name:DEFTEREOS, GEORGIOS (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGIOS
Middle Name:
Last Name:DEFTEREOS
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 1:1825 4TH STREET, BOX 4034
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-353-7043
Mailing Address - Fax:415-353-7676
Practice Address - Street 1:1825 4TH STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-353-7043
Practice Address - Fax:415-353-7676
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC181692207ZP0102X
WAMD60449870207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology