Healthcare Provider Details

I. General information

NPI: 1407869167
Provider Name (Legal Business Name): WILLIAM AARON MARKOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 MENDOCINO AVE STE 300
SANTA ROSA CA
95403-3634
US

IV. Provider business mailing address

3536 MENDOCINO AVE STE 200
SANTA ROSA CA
95403-3634
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3811
  • Fax: 707-544-0128
Mailing address:
  • Phone: 707-525-6485
  • Fax: 707-544-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA74621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: