Individual
DR. WILLIAM BRIAN WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1611 JOY LN, FORT MOHAVE, AZ 86426-8807
(928) 768-9496
Mailing address
P.0. BOX 9479, FORT MOHAVE, AZ 86426
(928) 768-9496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3527
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
518144
—
AZ
01
—
71873
PTAN
AZ
Enumeration date
09/14/2006
Last updated
01/05/2010
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