Provider Demographics
NPI:1649478223
Name:WILLIAM K. EBERT, M.D.
Entity type:Organization
Organization Name:WILLIAM K. EBERT, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-461-3344
Mailing Address - Street 1:7512 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4404
Mailing Address - Country:US
Mailing Address - Phone:805-461-3344
Mailing Address - Fax:
Practice Address - Street 1:7512 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4404
Practice Address - Country:US
Practice Address - Phone:805-461-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G777390Medicaid
CAW14614Medicare ID - Type Unspecified
CAC45753Medicare UPIN