Individual
MR. WILLIAM A. TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
438 SW COURT ST, DALLAS, OR 97338-1808
(503) 623-5984
Mailing address
438 SW COURT ST, DALLAS, OR 97338-1808
(503) 623-5984
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
512329
—
OR
Enumeration date
01/15/2008
Last updated
01/15/2008
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