Provider Demographics
NPI:1326127549
Name:WATERFIELD, WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WATERFIELD
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 1:2500 HOSPITAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4119
Mailing Address - Country:US
Mailing Address - Phone:650-968-3201
Mailing Address - Fax:650-968-2340
Practice Address - Street 1:2500 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4119
Practice Address - Country:US
Practice Address - Phone:650-968-3201
Practice Address - Fax:650-968-2340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU718ZOtherPTAN
A21054Medicare UPIN