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NPI 1063400471

NPI 1063400471 : WILLIAM M WASON MD : JOHNSON CITY, TN

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General NPI Number Information
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    NPI Number           |    1063400471
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    Entity Type          |    Individual 
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    Provider Name        |    WILLIAM M WASON MD
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/10/2005
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    325 N STATE OF FRANKLIN RD 
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    City                 |    JOHNSON CITY
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    State                |    TN
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    Zip                  |    37604-6062
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    Country              |    US
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    Telephone            |    423-439-7280
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    Fax                  |    423-439-8110
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Provider Business Mailing Address
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    Address Line         |    PO BOX 699 
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    City                 |    MOUNTAIN HOME
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    State                |    TN
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    Zip                  |    37684-0699
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    Country              |    US
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    Telephone            |    423-433-6039
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    Fax                  |    423-433-6060
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    207RR0500X
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    Taxonomy Name        |    Rheumatology Physician
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    License Number       |    MD38329
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    License Number State |    TN
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