Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 3243 | AZ |
N | 207V00000X | Obstetrician & Gynecologist | 55337 | MN |
N | 207V00000X | Obstetrician & Gynecologist | DR 00517757 | CO |
NPI | 1003929878 |
---|---|
Provider Name | William Charles Tindall |
First Address | Payson, AZ 85541-5618 |
Second Address | Payson, AZ 85541-5618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 12/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
455784-002 | (05) | AZ |
G88592 | (02) | AZ |