Provider Demographics
NPI:1780692814
Name:GAUSMAN, WILLIAM H JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:GAUSMAN
Suffix:JR
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 1:136 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7002
Mailing Address - Country:US
Mailing Address - Phone:805-736-1253
Mailing Address - Fax:805-736-3193
Practice Address - Street 1:136 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7002
Practice Address - Country:US
Practice Address - Phone:805-736-1253
Practice Address - Fax:805-736-3193
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19556207Q00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058550Medicaid
CAZZZ37313ZMedicaid
CAGR0058550Medicaid
770347953OtherANESTHESIA TIN
770347953OtherANESTHESIA TIN
CA080047891Medicare PIN
CAW13043Medicare ID - Type UnspecifiedANESTHESIA
95-2961001OtherVALLEY MEDICAL GROUP TIN
A86580Medicare UPIN