Healthcare Provider Details

I. General information

NPI: 1114488525
Provider Name (Legal Business Name): WILLIAM EARL MAES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR FAMILY MEDICINE DEPARTMENT
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

2221 CATHARINE ST
PHILADELPHIA PA
19146-1703
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-4071
  • Fax:
Mailing address:
  • Phone: 920-737-3656
  • Fax:

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 Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61476823
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: