Provider Demographics
NPI:1669761284
Name:HEYWARD, WILLIAM LANDRUM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LANDRUM
Last Name:HEYWARD
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 1:2929 SEVENTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2753
Mailing Address - Country:US
Mailing Address - Phone:510-665-0408
Mailing Address - Fax:510-848-9750
Practice Address - Street 1:2929 SEVENTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2753
Practice Address - Country:US
Practice Address - Phone:510-665-0408
Practice Address - Fax:510-848-9750
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist