Healthcare Provider Details

I. General information

NPI: 1730170978
Provider Name (Legal Business Name): WILLIAM G KUCZERPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 US HWY 431 STE. 210
BOAZ AL
35957-5967
US

IV. Provider business mailing address

2525 US HWY 431 STE. 210
BOAZ AL
35957-5967
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-4653
  • Fax: 256-840-3182
Mailing address:
  • Phone: 256-840-4653
  • Fax: 256-840-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number00022236
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number22236
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: