Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G65681 | CA |
Y | 208D00000X | General Practice Physician | G65681 | CA |
NPI | 1851697809 |
---|---|
Provider Name | William James Meecham |
First Address | Novato, CA 94949-6150 |
Second Address | San Rafael, CA 94903-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2011 |
Last Update Date | 08/02/2011 |