Healthcare Provider Details

I. General information

NPI: 1003348830
Provider Name (Legal Business Name): WILLIAM JAMES DEARDORFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/15/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE 15 LONG
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

505 PARNASSUS AVE 15 LONG
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-406-1417
  • Fax: 415-514-8192
Mailing address:
  • Phone: 415-406-1417
  • Fax: 415-514-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA169642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: