Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | D0071626 | MD |
Y | 2084N0400X | Neurologist | 2004024761 | MO |
NPI | 1184722258 |
---|---|
Provider Name | Dr. William David Strayhorn IV |
First Address | Frederick, MD 21702-0806 |
Second Address | Frederick, MD 21702-4397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009001301 | MO LICENSE (01) | MO |