Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101046585 | VA |
NPI | 1033140694 |
---|---|
Provider Name | Dr. William C Broaddus |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-0631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85883 | (02) |