Provider Demographics
NPI:1053608026
Name:KERRIDGE, WILLIAM DONALD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DONALD
Last Name:KERRIDGE
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 1:505 PARNASSUS AVE
Mailing Address - Street 2:ROOM M-391, BOX 0628
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-353-1821
Mailing Address - Fax:415-476-8482
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:ROOM M-391, BOX 0628
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-353-1821
Practice Address - Fax:415-476-8482
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142446390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA142446OtherMEDICAL LICENSE