Provider Demographics
NPI:1902009707
Name:MCCONNELL, WILLIAM ALLEN (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3435
Mailing Address - Fax:415-255-3567
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3435
Practice Address - Fax:415-255-3567
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5057OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
5057OtherSFGH INTERNAL USE ONLY