Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35433 | AL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35433 | AL |
NPI | 1629025838 |
---|---|
Provider Name | William K Mckibbin |
First Address | Tuscaloosa, AL 35403-2447 |
Second Address | Tuscaloosa, AL 35401-2055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 29/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1130W | BCBS (01) | NC |
891130W | (05) | NC |
G68594 | (02) | NC |