MEDICARE: WILLIAM RESSEGUIE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3579	AZ

General Provider Information

NPI Number	:	1093777625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM RESSEGUIE PA

Provider Business Mailing Address
First Line	:	5601 W EUGIE AVE
Second Line	:	SUITE 106
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-978-9255
Fax Number	:	602-230-9350

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE
Second Line	:	SUITE 106
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-978-9255
Fax Number	:	602-230-9350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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Directions to “ WILLIAM RESSEGUIE PA” Practice Location

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