Individual
WILLIAM JAMES WICKWIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 N PROSPECT AVE, STE 302, REDONDO BEACH, CA 90277-3043
(310) 798-1515
(310) 798-3131
Mailing address
520 N PROSPECT AVE, STE 302, REDONDO BEACH, CA 90277-3043
(310) 798-1515
(310) 798-3131
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G65083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G650830
—
CA
01
—
WG65083E
PTAN
CA
Enumeration date
06/08/2005
Last updated
02/21/2014
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