Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A169642 | CA |
NPI | 1003348830 |
---|---|
Provider Name | William James Deardorff |
First Address | San Francisco, CA 94143 |
Second Address | San Francisco, CA 94121-1563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 28/06/2021 |