MEDICARE: WILLIAM P MANSFIELD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35.079417	OH
2	2085R0202X	Diagnostic Radiology Physician	G63334	CA
3	207RM1200X	Magnetic Resonance Imaging (MRI) Internal Medicine Physician	G63334	CA
4	207NS0135X	Procedural Dermatology Physician	G63334	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300121591	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000196899	OTHER	OH	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467421917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM P MANSFIELD M.D.

Provider Business Mailing Address
First Line	:	406 9TH AVE
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7276
Country	:	US
Telephone Number	:	619-338-0911
Fax Number	:	619-338-0933

Provider Business Practice Location Address
First Line	:	406 9TH AVE
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7276
Country	:	US
Telephone Number	:	619-338-0911
Fax Number	:	619-338-0933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/18/2014

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Directions to “ WILLIAM P MANSFIELD M.D.” Practice Location

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