Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | WV18114 | WV |
NPI | 1851445225 |
---|---|
Provider Name | William R Carson |
First Address | Summersville, WV 26651-0927 |
Second Address | Summersville, WV 26651-9308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0098219000 | (05) | WV |
0786513 | MEDICARE PROVIDER NUMBER (01) | WV |
G07157 | (02) | WV |