Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1546 | TX |
NPI | 1134286024 |
---|---|
Provider Name | Dr. William Robert Rediske |
First Address | Killeen, TX 76549-4984 |
Second Address | Killeen, TX 76549-4984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 18/11/2015 |