Healthcare Provider Details

I. General information

NPI: 1710925144
Provider Name (Legal Business Name): WILLIAM D MCINTYRE, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S FAIR OAKS AVE
PASADENA CA
91105-2603
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 626-304-4400
  • Fax: 626-296-3457
Mailing address:
  • Phone: 714-443-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG29828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: