Provider Demographics
NPI:1366456246
Name:MENZIES, WILLIAM RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:MENZIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3699
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8699
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:18785 S. BROOKHURST STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-378-5330
Practice Address - Fax:714-378-5320
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43758Medicare UPIN
CACB224676Medicare PIN