Healthcare Provider Details

I. General information

NPI: 1487690566
Provider Name (Legal Business Name): WILLIAM NORRIS KAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 FIRST AVENUE NORTH
ILWACO WA
98624
US

IV. Provider business mailing address

PO BOX N
ILWACO WA
98624-0319
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3747
  • Fax: 360-642-3361
Mailing address:
  • Phone: 360-642-3747
  • Fax: 360-642-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00040609
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: