Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | M4223 | ID |
NPI | 1023013299 |
---|---|
Provider Name | Dr. William C. Fitzhugh |
First Address | Twin Falls, ID 83301-3250 |
Second Address | Twin Falls, ID 83301-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002542302 | (05) | ID |
1023013299 | (02) | ID |