1124004791 NPI number — WILLIAM T. PROSSER CRNA

Table of content: THOMAS DEAN BIDDISON M.D. (NPI 1669402327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124004791 NPI number — WILLIAM T. PROSSER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROSSER
Provider First Name:
WILLIAM
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124004791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 V ST
Provider Second Line Business Mailing Address:
PSSB-SUITE 1200, MED: ANESTHESIA
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-7985
Provider Business Mailing Address Fax Number:
916-734-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 V ST
Provider Second Line Business Practice Location Address:
PSSB-SUITE 1200, MED: ANESTHESIA
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7985
Provider Business Practice Location Address Fax Number:
916-734-2975
Provider Enumeration Date:
12/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  421995/2277 RN/CRNA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006406 . This is a "PHYSICIAN INDEX #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".