Provider Demographics
NPI:1730241100
Name:KEIGHTLEY, WILLIAM CHASE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHASE
Last Name:KEIGHTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. CHURCH STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIAI
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-739-3954
Mailing Address - Fax:805-739-3060
Practice Address - Street 1:116 S PALISADE DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8905
Practice Address - Country:US
Practice Address - Phone:805-739-3968
Practice Address - Fax:805-739-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG391382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry