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General NPI Number Information
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NPI Number | 1407199706
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Entity Type | Individual
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Provider Name | WILLIAM ENNIS JR. P.A.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 914A EASTERN SHORE DR
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City | SALISBURY
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State | MD
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Zip | 21804-6410
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Country | US
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Telephone | 410-546-1331
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Fax | 410-543-8107
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Provider Business Mailing Address
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Address Line | 914A EASTERN SHORE DR
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City | SALISBURY
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State | MD
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Zip | 21804-6410
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Country | US
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Telephone | 410-546-1331
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Fax | 410-543-8107
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C05019
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License Number State | MD
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