Provider Demographics
NPI:1548286511
Name:RICH, WILLIAM MAX (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAX
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6323 N FRESNO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5282
Practice Address - Country:US
Practice Address - Phone:559-431-2443
Practice Address - Fax:559-431-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28911207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G289111Medicaid
CA00G289110Medicaid
CAA43910Medicare UPIN