Individual
DR. WILLARD RANDOLPH VANNOSTRAND III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1260 S CAMPBELL AVE BLDG 2, GREEN VALLEY, AZ 85614-0502
(520) 407-5400
(520) 407-5990
Mailing address
1260 S CAMPBELL AVE BLDG 2, GREEN VALLEY, AZ 85614-0502
(520) 407-5600
(520) 407-5990
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
7028
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01WCFBXA1
MEDICARE BILLING NO.
AZ
Enumeration date
10/13/2009
Last updated
08/23/2022
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