Doctor Name: | DR. WILLIAM B KRISSOFF |
NPI Number: | 1245346790 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G26823 |
Business Practice Address: | 10051 Lake Ave Suite 4 Truckee, CA - 961614825 |
Business Phone Number: | 5305820202 |
Business Fax Number: | 5305820206 |
Mailing Address: | 10051 Lake Ave, Suite 4 TRUCKEE |
State: | CA |
Postal Code: | 961614825 |
Phone Number: | 5305820202 |
Fax Number: | 5305820206 |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204C00000X |
License Number: | G26823 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
Taxonomy Specialization: | |
Taxonomy Definition: |