Provider Demographics
NPI:1225182025
Name:WILLIAM P AULL,M.D.
Entity Type:Organization
Organization Name:WILLIAM P AULL,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:AULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-454-3363
Mailing Address - Street 1:17160 AVENIDA DE SANTA YNEZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2133
Mailing Address - Country:US
Mailing Address - Phone:310-454-3363
Mailing Address - Fax:
Practice Address - Street 1:15332 ANTIOCH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3603
Practice Address - Country:US
Practice Address - Phone:310-454-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50609261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50609Medicare UPIN