Provider Demographics
NPI:1548312697
Name:ROSS, WILLIAM CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLAYTON
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-0808
Mailing Address - Country:US
Mailing Address - Phone:925-934-3536
Mailing Address - Fax:925-934-0672
Practice Address - Street 1:1777 BOTELHO DR
Practice Address - Street 2:SUITE #110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5086
Practice Address - Country:US
Practice Address - Phone:925-934-3536
Practice Address - Fax:925-934-0672
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24231207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42205Medicare UPIN
00G242310Medicare ID - Type Unspecified