Provider Demographics
NPI:1104862689
Name:TATOMER, WILLIAM REEVES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REEVES
Last Name:TATOMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-342-4442
Mailing Address - Fax:650-342-8816
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-342-4442
Practice Address - Fax:650-342-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC355372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36014Medicare UPIN