Basic Information
| Provider Information | |||||||||
| NPI: | 1396983094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM L EBBELING MD INC APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1646 E HERNDON AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594900234 | ||||||||
| FaxNumber: | 5594900237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1646 E HERNDON AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594900234 | ||||||||
| FaxNumber: | 5594900237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | EBBELING | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | LEONARD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5594900234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | C50225 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.