Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4637 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4637 | KY |
NPI | 1033220280 |
---|---|
Provider Name | Dr. William Douglas Shaver |
First Address | Owensboro, KY 42303-6295 |
Second Address | Owensboro, KY 42303-6295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60046372 | (05) | KY |
64046378 | (05) | KY |
T54036 | (02) | KY |