Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 039204 | GA |
NPI | 1003840463 |
---|---|
Provider Name | William O Prince |
First Address | Fort Lauderdale, FL 33355-1420 |
Second Address | Atlanta, GA 30309-1281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G36561 | (02) |