MEDICARE: WILLIAM MARK DOLAN III MD

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	207L00000X	Anesthesiology Physician	C31652	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	:	1639125420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MARK DOLAN III MD

Provider Business Mailing Address
First Line	:	771 WOODSTOCK LN
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-3965
Country	:	US
Telephone Number	:	650-941-8567
Fax Number	:	650-941-8322

Provider Business Practice Location Address
First Line	:	771 WOODSTOCK LN
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-3965
Country	:	US
Telephone Number	:	650-941-8567
Fax Number	:	650-941-8322

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/09/2010

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