MEDICARE: DR. WILLIAM NISBET M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	10771	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750317293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM NISBET M.D.

Provider Business Mailing Address
First Line	:	960 LIBERTY ST SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4165
Country	:	US
Telephone Number	:	503-364-5033
Fax Number	:	503-364-4820

Provider Business Practice Location Address
First Line	:	960 LIBERTY ST SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4165
Country	:	US
Telephone Number	:	503-364-5033
Fax Number	:	503-364-4820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	12/11/2012

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