Provider Demographics
NPI:1710971346
Name:SPEITEL, WILLIAM ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALFRED
Last Name:SPEITEL
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:124 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2810
Practice Address - Country:US
Practice Address - Phone:805-641-9880
Practice Address - Fax:805-641-9890
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34840207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348400Medicaid
CAA34840Medicare PIN
CAA84702Medicare UPIN
CA00A348400Medicaid