Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS5916 | FL |
NPI | 1538144407 |
---|---|
Provider Name | William Harry Stager |
First Address | West Palm Beach, FL 33407-5509 |
Second Address | West Palm Beach, FL 33407-5509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F22128 | (02) | FL |
OS5916 | LICENSE (01) | FL |