Healthcare Provider Details

I. General information

NPI: 1407858624
Provider Name (Legal Business Name): H. WILLIAM ADKISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 VIA MANZANA
TAOS NM
87571-5411
US

IV. Provider business mailing address

735 VIA MANZANA
TAOS NM
87571-5411
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-2224
  • Fax: 505-758-4903
Mailing address:
  • Phone: 505-758-2224
  • Fax: 505-758-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number74-111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: