Provider Demographics
NPI:1275600694
Name:WILLIAM P. SWEEZER JR., M.D., INC.
Entity Type:Organization
Organization Name:WILLIAM P. SWEEZER JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLISIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-676-2600
Mailing Address - Street 1:2485 HIGH SCHOOL AVE.
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520
Mailing Address - Country:US
Mailing Address - Phone:925-676-2600
Mailing Address - Fax:925-680-0212
Practice Address - Street 1:2485 HIGH SCHOOL AVE.
Practice Address - Street 2:SUITE 312
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-676-2600
Practice Address - Fax:925-680-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37761Medicare UPIN
CA00C422110Medicare ID - Type Unspecified