Healthcare Provider Details

I. General information

NPI: 1184735953
Provider Name (Legal Business Name): WILLIAM R ALEX MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 14TH ST STE 306
RIVERSIDE CA
92501-4083
US

IV. Provider business mailing address

4000 14TH ST STE 306
RIVERSIDE CA
92501-4083
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-2036
  • Fax: 951-682-2942
Mailing address:
  • Phone: 951-682-2036
  • Fax: 951-682-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG86010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberG86010
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG86010
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG86010
License Number StateCA

VIII. Authorized Official

Name: WILLIAM R ALEX
Title or Position: PRESIDENT
Credential: MD
Phone: 909-732-4148