Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | M-3347 | ID |
NPI | 1043697576 |
---|---|
Provider Name | William Chapman |
First Address | Coeur D Alene, ID 83816-1118 |
Second Address | Coeur D Alene, ID 83814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 05/05/2015 |