Healthcare Provider Details

I. General information

NPI: 1225361629
Provider Name (Legal Business Name): WILLIAM JERVIS, M.D., F. A. C. S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE 109
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE 109
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-7100
  • Fax: 925-937-3896
Mailing address:
  • Phone: 925-937-7100
  • Fax: 925-937-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG8005
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM HORACE JERVIS JR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 925-937-7100