Healthcare Provider Details

I. General information

NPI: 1841292935
Provider Name (Legal Business Name): WILLIAM W GORAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE STE 503
SAN BERNARDINO CA
92404-3873
US

IV. Provider business mailing address

355 E 21ST ST STE E
SAN BERNARDINO CA
92404-4851
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-6474
  • Fax: 909-882-5485
Mailing address:
  • Phone: 909-882-6474
  • Fax: 909-886-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG51095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: