Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7540 | TX |
NPI | 1023053667 |
---|---|
Provider Name | William C. Rast, Jr |
First Address | El Paso, TX 79932-3034 |
Second Address | El Paso, TX 79912-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |