Healthcare Provider Details

I. General information

NPI: 1578625141
Provider Name (Legal Business Name): WILLIAM A MCGANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST
SAN FRANCISCO CA
94117-1016
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-0665
  • Fax: 415-221-0687
Mailing address:
  • Phone: 916-379-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG41054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: