Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 35043493R | OH |
NPI | 1174595748 |
---|---|
Provider Name | William Kennard Rundell |
First Address | Dayton, OH 45409 |
Second Address | Dayton, OH 45409-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 20/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0413065 | (05) | OH |
B96450 | (02) | OH |