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General NPI Number Information
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NPI Number | 1982853743
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Entity Type | Individual
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Provider Name | WILLIAM DEHAAN III BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 1062 EAGLERIDGE BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2130
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Country | US
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Telephone | 719-569-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1062 EAGLERIDGE BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2130
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Country | US
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Telephone | 719-569-5000
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Fax |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 149
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License Number State | CO
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