Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 17389 | CO |
NPI | 1003928862 |
---|---|
Provider Name | Dr. William Arnold Bevan JR. |
First Address | Edwards, CO 81632-8109 |
Second Address | Vail, CO 81657-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1173897 | (05) | CO |
E40423 | (02) |