Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G-30707 | CA |
NPI | 1679544472 |
---|---|
Provider Name | Dr. William Sickles Halsey III |
First Address | La Jolla, CA 92037-1223 |
Second Address | La Jolla, CA 92037-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 02/11/2013 |