Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 01026942A | IN |
NPI | 1063410942 |
---|---|
Provider Name | William R Nunery |
First Address | Indianapolis, IN 46280-2301 |
Second Address | Indianapolis, IN 46280-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 28/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100351370 | (05) | IN |
B28332 | (02) | IN |