Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 042.0010731 | VT |
NPI | 1447208269 |
---|---|
Provider Name | William Bradford Hoge Bissell |
First Address | Rutland, VT 05701 |
Second Address | Rutland, VT 05701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 04/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I09718 | (02) |