Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 573149 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD.36977 | AL |
NPI | 1144665233 |
---|---|
Provider Name | William Gage Liesman |
First Address | Birmingham, AL 35205-1638 |
Second Address | Birmingham, AL 35205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2013 |
Last Update Date | 27/06/2018 |