Healthcare Provider Details

I. General information

NPI: 1851697809
Provider Name (Legal Business Name): WILLIAM JAMES MEECHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 REDWOOD HWY STE 4
SAN RAFAEL CA
94903-2600
US

IV. Provider business mailing address

23 SERRA CT
NOVATO CA
94949-6150
US

V. Phone/Fax

Practice location:
  • Phone: 415-472-4021
  • Fax:
Mailing address:
  • Phone: 415-599-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberG65681
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG65681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: