Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PS00000120 | WA |
N | 222Z00000X | Podiatrist | PS00000120 | WA |
N | 224P00000X | Prosthetist | PS00000119 | WA |
NPI | 1285674259 |
---|---|
Provider Name | Mr. Alan Charles Williams |
First Address | Spokane, WA 99208 |
Second Address | Spokane, WA 99201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8418717 | PIN MEDICAID (01) | WA |
9011495 | (05) | WA |
CO002920 | ABC NUMBER (01) |