Healthcare Provider Details

I. General information

NPI: 1619062007
Provider Name (Legal Business Name): WILLIAM POLLOCK BARLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 FOWLER WAY SUITE #1
PLACERVILLE CA
95667
US

IV. Provider business mailing address

1004 FOWLER WAY SUITE #1
PLACERVILLE CA
95667
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-8003
  • Fax: 530-626-8082
Mailing address:
  • Phone: 530-626-8003
  • Fax: 530-626-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG72071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: