Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | AZ3750 | AZ |
N | 207Q00000X | Family Doctor | AZ3750 | AZ |
NPI | 1629175104 |
---|---|
Provider Name | Anthony Michael Will |
First Address | Glendale, AZ 85308-6813 |
Second Address | Glendale, AZ 85308-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 02/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
756207 | (05) | AZ |
H38606 | (02) | AZ |