Provider Demographics
NPI:1255373874
Name:KINCANNON, WILLIAM N (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:KINCANNON
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 1:2403 CASTILLO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5316
Mailing Address - Country:US
Mailing Address - Phone:805-563-6560
Mailing Address - Fax:805-563-3680
Practice Address - Street 1:2403 CASTILLO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5316
Practice Address - Country:US
Practice Address - Phone:805-563-6560
Practice Address - Fax:805-563-3680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G55191Medicare ID - Type UnspecifiedSTATE LISCENCE NUMBER