Provider Demographics
NPI:1639125420
Name:DOLAN, WILLIAM MARK III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:DOLAN
Suffix:III
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 1:771 WOODSTOCK LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3965
Mailing Address - Country:US
Mailing Address - Phone:650-941-8567
Mailing Address - Fax:650-941-8322
Practice Address - Street 1:771 WOODSTOCK LN
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3965
Practice Address - Country:US
Practice Address - Phone:650-941-8567
Practice Address - Fax:650-941-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31652207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C316520Medicaid
CA00C316520Medicaid
A34661Medicare UPIN