Provider Demographics
NPI:1396893046
Name:OKERBLOM, WILLIAM ALLEN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:OKERBLOM
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 1:1103 DEVONSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3444
Mailing Address - Country:US
Mailing Address - Phone:805-478-6570
Mailing Address - Fax:866-317-4919
Practice Address - Street 1:1103 DEVONSHIRE PL
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3444
Practice Address - Country:US
Practice Address - Phone:805-478-6570
Practice Address - Fax:866-317-4919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GI162AOtherPTAN
CAP00465406OtherMEDICARE RAILROAD
CAP00465406OtherMEDICARE RAILROAD
CAWG49571AMedicare PIN