Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 29584 | GA |
NPI | 1013907880 |
---|---|
Provider Name | Dr. William Bizzaro |
First Address | Atlanta, GA 30308-2209 |
Second Address | Roswell, GA 30076-4907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00350402D | (05) | GA |
D28939 | (02) | GA |