Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 74-134 | NM |
NPI | 1033236518 |
---|---|
Provider Name | William J Chesnut |
First Address | Albuquerque, NM 87102-2568 |
Second Address | Albuquerque, NM 87102-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39855571 | (05) | NM |
E51948 | (02) |