Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | DPM.200071 | LA |
N | 2081S0010X | Sports Medicine | DPM.200071 | LA |
N | 213ES0000X | Sports Medicine | DPM.200071 | LA |
Y | 213ES0103X | Foot & Ankle Surgery | DPM.200071 | LA |
NPI | 1417316258 |
---|---|
Provider Name | Dr. William Andress |
First Address | Shreveport, LA 71106-8158 |
Second Address | Shreveport, LA 71106-8158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 22/02/2016 |