Healthcare Provider Details

I. General information

NPI: 1992892624
Provider Name (Legal Business Name): WILLIAM J AUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001
US

IV. Provider business mailing address

1200 N BEAVER ST
FLAGSTAFF AZ
86001
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-3956
  • Fax: 928-773-2286
Mailing address:
  • Phone: 928-773-2054
  • Fax: 928-773-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: