MEDICARE: WILLIAM SOLOMON RDCS, RVS, BS

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	246XC2903X	Vascular Specialist/Technologist Cardiovascular	106581

General Provider Information

NPI Number	:	1356764146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SOLOMON RDCS, RVS, BS

Provider Business Mailing Address
First Line	:	6937 LOMA VISTA DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-6428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6937 LOMA VISTA DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-6428
Country	:	US
Telephone Number	:	682-553-1411
Fax Number	:

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

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	01/29/2014

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