Healthcare Provider Details

I. General information

NPI: 1669761284
Provider Name (Legal Business Name): WILLIAM LANDRUM HEYWARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 SEVENTH ST SUITE 100
BERKELEY CA
94710-2753
US

IV. Provider business mailing address

2929 SEVENTH ST SUITE 100
BERKELEY CA
94710-2753
US

V. Phone/Fax

Practice location:
  • Phone: 510-665-0408
  • Fax: 510-848-9750
Mailing address:
  • Phone: 510-665-0408
  • Fax: 510-848-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC53479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: