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General NPI Number Information
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NPI Number | 1386902492
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Entity Type | Individual
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Provider Name | WILLIAM DESMOND BEVEL RT (R)
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Gender | Male
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 1001 SOUTH MARSHALL STREET SUITE 1-71 MAILBOX #2
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City | WINSTON-SALEM
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State | NC
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Zip | 27101-5401
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Country | US
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Telephone | 336-602-3822
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Fax | 800-665-3903
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Provider Business Mailing Address
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Address Line | 1001 SOUTH MARSHALL STREET SUITE 1-71 MAILBOX #2
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City | WINSTON-SALEM
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State | NC
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Zip | 27101-5401
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Country | US
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Telephone | 336-602-3822
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Fax | 800-665-3903
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | CRT 33615
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License Number State | FL
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