Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | PA8298 | MA |
NPI | 1134883432 |
---|---|
Provider Name | William Churchill Lary IV |
First Address | Hyannis, MA 02601-5245 |
Second Address | Hyannis, MA 02601-5245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 25/10/2021 |