Provider Demographics
NPI:1447202742
Name:NESBITT, WILLIAM REYNOLDS III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REYNOLDS
Last Name:NESBITT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2210 DEL PASO RD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9676
Practice Address - Country:US
Practice Address - Phone:916-285-8110
Practice Address - Fax:916-285-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-09-08
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Provider Licenses
StateLicense IDTaxonomies
CAG0372980207QG0300X
CAG37298207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA204096277OtherTAX IDENTIFICATION NUMBER
CAA47030Medicare UPIN