Provider Demographics
NPI:1891723359
Name:DOWNEY, WILLIAM CHRISTPHER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTPHER
Last Name:DOWNEY
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 1:1055 WESTGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1065
Mailing Address - Country:US
Mailing Address - Phone:651-635-9173
Mailing Address - Fax:612-262-7022
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:PROVIDER ENROLLMENT
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:612-262-1166
Practice Address - Fax:612-262-4258
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25422207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400168822OtherMEDICARE PTAN
MN626367400Medicaid
MN080001173Medicare ID - Type Unspecified
MNH400168822OtherMEDICARE PTAN