=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235159435
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM O SARGEANT D.O.,P.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1758 PARK PLACE SUITE 100
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-265-8455
-----------------------------------------------------
Fax | 334-834-6724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1758 PARK PLACE SUITE 100
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-265-8455
-----------------------------------------------------
Fax | 334-834-6724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | D0257
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------