MEDICARE: WILLIAM DOUGLAS BOCASH 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	208000000X	Pediatrics Physician	G058470	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497758171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DOUGLAS BOCASH M.D.

Provider Business Mailing Address
First Line	:	2486 N PONDEROSA DR
Second Line	:	STE D211
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2376
Country	:	US
Telephone Number	:	805-484-2818
Fax Number	:	805-482-0028

Provider Business Practice Location Address
First Line	:	2486 N PONDEROSA DR
Second Line	:	STE D211
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2376
Country	:	US
Telephone Number	:	805-484-2818
Fax Number	:	805-482-0028

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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