Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | C-4737 | AR |
NPI | 1033134218 |
---|---|
Provider Name | William C Mcbryde |
First Address | Bono, AR 72416-9613 |
Second Address | Jonesboro, AR 72401-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D16983 | (02) | AR |