Healthcare Provider Details

I. General information

NPI: 1023103421
Provider Name (Legal Business Name): WILLIAM C ELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 12
HETTINGER ND
58639
US

IV. Provider business mailing address

1100 HIGHWAY 12
HETTINGER ND
58639-7533
US

V. Phone/Fax

Practice location:
  • Phone: 701-567-4561
  • Fax: 701-567-6301
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3444
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: