Provider Demographics
NPI:1700948189
Name:WALNUT CREEK ORTHOPEDICS AND SPORTS MEDICINE, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WALNUT CREEK ORTHOPEDICS AND SPORTS MEDICINE, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-944-0110
Mailing Address - Street 1:101 YGNACIO VALLEY RD
Mailing Address - Street 2:400
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4087
Mailing Address - Country:US
Mailing Address - Phone:925-944-0110
Mailing Address - Fax:925-944-0960
Practice Address - Street 1:101 YGNACIO VALLEY RD
Practice Address - Street 2:400
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4087
Practice Address - Country:US
Practice Address - Phone:925-944-0110
Practice Address - Fax:925-944-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X, 207RS0010X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700948189OtherNPI
CA5770390001Medicare NSC
CAZZZ29820ZMedicare ID - Type Unspecified