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General NPI Number Information
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NPI Number | 1851404859
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Entity Type | Individual
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Provider Name | WILLIAM LEO FANGMAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 959 COX RD
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City | GASTONIA
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State | NC
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Zip | 28054-3420
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Country | US
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Telephone | 704-866-7576
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Fax | 704-866-0106
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Provider Business Mailing Address
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Address Line | 1072 X RAY DR
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City | GASTONIA
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State | NC
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Zip | 28054-7498
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Country | US
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Telephone | 704-691-1074
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Fax | 704-671-1095
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 200201075
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME100630
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2019-00293
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License Number State | NC
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