Provider Demographics
NPI:1003348830
Name:DEARDORFF, WILLIAM JAMES
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DEARDORFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:15 LONG
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-406-1417
Mailing Address - Fax:415-514-8192
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:15 LONG
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-406-1417
Practice Address - Fax:415-514-8192
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA169642207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program