Healthcare Provider Details

I. General information

NPI: 1336150226
Provider Name (Legal Business Name): WILLIAM LEE HEREFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

108 MACTANLY PL
STAUNTON VA
24401-2373
US

IV. Provider business mailing address

108 MACTANLY PL
STAUNTON VA
24401-2373
US

V. Phone/Fax

Practice location:
  • Phone: 540-885-1281
  • Fax: 540-213-2208
Mailing address:
  • Phone: 540-885-1281
  • Fax: 540-213-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101043705
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: