Healthcare Provider Details

I. General information

NPI: 1245589597
Provider Name (Legal Business Name): WILLIAM MEFFERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MINOCA RD
PORTOLA VALLEY CA
94028-7767
US

IV. Provider business mailing address

406 MINOCA RD
PORTOLA VALLEY CA
94028-7767
US

V. Phone/Fax

Practice location:
  • Phone: 650-529-0498
  • Fax: 650-529-0497
Mailing address:
  • Phone: 650-529-0498
  • Fax: 650-529-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number18184
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: