Provider Demographics
NPI:1396758306
Name:PETRAS, WILLIAM D (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:PETRAS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:760-674-3845
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-674-3847
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8158207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX81580Medicaid
CAH52214Medicare UPIN
CA00AX81580Medicaid