Basic Information
| Provider Information | |||||||||
| NPI: | 1700948189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALNUT CREEK ORTHOPEDICS AND SPORTS MEDICINE, PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 YGNACIO VALLEY RD | ||||||||
| Address2: | 400 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945964087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259440110 | ||||||||
| FaxNumber: | 9259440960 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 YGNACIO VALLEY RD | ||||||||
| Address2: | 400 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945964087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259440110 | ||||||||
| FaxNumber: | 9259440960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 12/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | WORKMAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9259440110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207XX0005X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207RS0010X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207X00000X | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1700948189 | 01 | CA | NPI | OTHER |