Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5582 | AL |
NPI | 1205107299 |
---|---|
Provider Name | William Gates III |
First Address | Mobile, AL 36608-1913 |
Second Address | Mobile, AL 36608-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |