Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 074163-1 | NY |
NPI | 1053797720 |
---|---|
Provider Name | John Williams |
First Address | Naples, FL 34103-3471 |
Second Address | Naples, FL 34103-3471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
074163-1 | LICENSE NUMBER (01) | NY |