Provider Demographics
NPI:1699800219
Name:ANDERECK, WILLIAM STANLEY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STANLEY
Last Name:ANDERECK
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 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3025
Mailing Address - Fax:415-749-5720
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 418
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3025
Practice Address - Fax:415-749-5720
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G334090Medicaid
CA00G334090Medicare ID - Type UnspecifiedMEDICARE
CA00G334090Medicaid