Healthcare Provider Details

I. General information

NPI: 1003929878
Provider Name (Legal Business Name): WILLIAM CHARLES TINDALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST SUITE A
PAYSON AZ
85541-5618
US

IV. Provider business mailing address

120 E MAIN ST SUITE A
PAYSON AZ
85541-5618
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-9744
  • Fax:
Mailing address:
  • Phone: 928-474-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3243
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR 00517757
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number55337
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: