Healthcare Provider Details

I. General information

NPI: 1114062684
Provider Name (Legal Business Name): WILLIAM ALEXANDER MCLEOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 H ST SUITE 2
MARYSVILLE CA
95901-5834
US

IV. Provider business mailing address

2114 HILLRIDGE DR
FAIRFIELD CA
94534-7949
US

V. Phone/Fax

Practice location:
  • Phone: 530-742-7747
  • Fax: 530-742-7642
Mailing address:
  • Phone: 707-344-4005
  • Fax: 707-429-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A6631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: