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NPI Code Detail

MEDICARE: WILLIAM MINER MAGUIRE JR.

MEDICARE: WILLIAM MINER MAGUIRE JR.
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
1174400000XSpecialist13143CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113143OTHERCACERTIFIED ADDICTION SPECIALIST

General Provider Information

NPI Number : 1558781104
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM MINER MAGUIRE JR.
Provider Business Mailing Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-265-9045
Fax Number : 530-477-7977
Provider Business Practice Location Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-265-9045
Fax Number : 530-477-7977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2014
Last Update Date : 04/22/2014

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