Provider Demographics
NPI:1184790784
Name:MADSEN, PARLEY WILLIAM III (MD)
Entity type:Individual
Prefix:DR
First Name:PARLEY
Middle Name:WILLIAM
Last Name:MADSEN
Suffix:III
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 1:306 N CONYER ST
Mailing Address - Street 2:STE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4704
Mailing Address - Country:US
Mailing Address - Phone:559-625-1054
Mailing Address - Fax:559-625-1385
Practice Address - Street 1:306 N CONYER ST
Practice Address - Street 2:STE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4704
Practice Address - Country:US
Practice Address - Phone:559-625-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51505207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29680ZMedicare ID - Type Unspecified
CAE83795Medicare UPIN