Healthcare Provider Details

I. General information

NPI: 1659345254
Provider Name (Legal Business Name): WILLIAM KING CHAPMAN JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4628 GEORGETOWN PL
STOCKTON CA
95207-6204
US

IV. Provider business mailing address

4628 GEORGETOWN PL
STOCKTON CA
95207-6204
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-6177
  • Fax: 209-478-6219
Mailing address:
  • Phone: 209-478-6177
  • Fax: 209-478-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPA11701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: