Provider Demographics
NPI:1801882683
Name:SWEET, WILLIAM EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:SWEET
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27787
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0126
Mailing Address - Country:US
Mailing Address - Phone:760-320-7276
Mailing Address - Fax:760-322-0132
Practice Address - Street 1:400 S FARRELL DR
Practice Address - Street 2:B-101
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7964
Practice Address - Country:US
Practice Address - Phone:760-320-7276
Practice Address - Fax:760-322-0132
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-02-14
Deactivation Date:2006-04-05
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAE2665213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E26650Medicaid
CA000E26650Medicare ID - Type Unspecified
CA4864920001Medicare NSC
CA000E26650Medicaid