Provider Demographics
NPI:1699888727
Name:CARRAGHER, WILLIAM MICHAEL III (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:CARRAGHER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:MICHAEL
Other - Last Name:CARRAGHER
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:7235 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6724
Mailing Address - Country:US
Mailing Address - Phone:805-823-8204
Mailing Address - Fax:805-823-8209
Practice Address - Street 1:7235 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6724
Practice Address - Country:US
Practice Address - Phone:805-823-8204
Practice Address - Fax:805-823-8209
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7692207Q00000X, 208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7692OtherBLUE CROSS PROVIDER NUM
CA20A7692OtherBLUE CROSS PROVIDER NUM