Healthcare Provider Details

I. General information

NPI: 1497772016
Provider Name (Legal Business Name): WILLIAM ERVIN I M.D., FACEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM ERVIN M.D., FACEP

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 QUAIL RUN DR
MANAKIN SABOT VA
23103-2615
US

IV. Provider business mailing address

7 QUAIL RUN DR
MANAKIN SABOT VA
23103-2615
US

V. Phone/Fax

Practice location:
  • Phone: 804-784-4614
  • Fax:
Mailing address:
  • Phone: 804-784-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101034662
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46824
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2013-0607
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD169795
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60770-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: