Provider Demographics
NPI:1891174785
Name:ENTWISTLE, WILLIAM MILTON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MILTON
Last Name:ENTWISTLE
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 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0134
Practice Address - Street 1:3385 G ST STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0980
Practice Address - Country:US
Practice Address - Phone:097-253-1222
Practice Address - Fax:209-725-3128
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153095207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine