Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2672 | LA |
NPI | 1023258530 |
---|---|
Provider Name | Dr. William Herrick Wayman |
First Address | Mandeville, LA 70448-1914 |
Second Address | Covington, LA 70433-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 23/02/2009 |