Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A17020 | CA |
NPI | 1225145873 |
---|---|
Provider Name | Dr. William Charles Fowkes JR. |
First Address | La Honda, CA 94020 |
Second Address | La Honda, CA 94020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |