Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 19014689 | IL |
NPI | 1073592093 |
---|---|
Provider Name | William Joseph Starsiak JR. |
First Address | Pensacola, FL 32512-0003 |
Second Address | Pensacola, FL 32512-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 19/07/2007 |