Healthcare Provider Details

I. General information

NPI: 1831145432
Provider Name (Legal Business Name): WILLIAM GARDINER SEAVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 3900
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

5960 11TH AVE
SACRAMENTO CA
95820-2432
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5496
  • Fax: 916-456-9350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number00A611630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: