Provider Demographics
NPI:1225361629
Name:WILLIAM JERVIS, M.D., F. A. C. S., INC.
Entity Type:Organization
Organization Name:WILLIAM JERVIS, M.D., F. A. C. S., INC.
Other - Org Name:ADVANCED COSMETIC SURGERY OF WALNUT CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HORACE
Authorized Official - Last Name:JERVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:925-937-7100
Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-937-7100
Mailing Address - Fax:925-937-3896
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-937-7100
Practice Address - Fax:925-937-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8005261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA58137Medicare UPIN
CA000G80050Medicare PIN