Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD38329 | TN |
NPI | 1063400471 |
---|---|
Provider Name | William M Wason |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C24665 | (02) |