Provider Demographics
NPI:1437153954
Name:ENGSTROM, WILLIAM GARY (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GARY
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4316
Mailing Address - Country:US
Mailing Address - Phone:336-887-3195
Mailing Address - Fax:336-887-3194
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:STE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4316
Practice Address - Country:US
Practice Address - Phone:336-887-3195
Practice Address - Fax:336-887-3194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102364207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S65729Medicare UPIN
NC2746443AMedicare ID - Type Unspecified