Provider Demographics
NPI:1225145873
Name:FOWKES, WILLIAM CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:FOWKES
Suffix:JR
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 1:22280 SKYLINE BLVD.
Mailing Address - Street 2:
Mailing Address - City:LA HONDA
Mailing Address - State:CA
Mailing Address - Zip Code:94020
Mailing Address - Country:US
Mailing Address - Phone:650-941-4684
Mailing Address - Fax:650-941-4684
Practice Address - Street 1:ROUTE 2, BOX 329
Practice Address - Street 2:
Practice Address - City:LA HONDA
Practice Address - State:CA
Practice Address - Zip Code:94020
Practice Address - Country:US
Practice Address - Phone:650-941-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17020207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine