Provider Demographics
NPI:1659436392
Name:FEE, WILLARD E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:E
Last Name:FEE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:WILLARD
Other - Middle Name:E
Other - Last Name:FEE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3705 BRANDY ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1900
Mailing Address - Country:US
Mailing Address - Phone:650-787-5294
Mailing Address - Fax:650-780-9369
Practice Address - Street 1:3705 BRANDY ROCK WAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1900
Practice Address - Country:US
Practice Address - Phone:650-787-5294
Practice Address - Fax:650-780-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG019012207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40482Medicare UPIN