Provider Demographics
NPI:1497801112
Name:WILL, ALBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DOUGLAS
Last Name:WILL
Suffix:
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:PO BOX 21530
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-1530
Mailing Address - Country:US
Mailing Address - Phone:775-884-2455
Mailing Address - Fax:775-884-0345
Practice Address - Street 1:152 PIONEER LN
Practice Address - Street 2:SUITE A
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2563
Practice Address - Country:US
Practice Address - Phone:760-873-2605
Practice Address - Fax:760-873-2769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG402192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48145Medicare UPIN