Basic Information
Provider Information
NPI: 1093923393
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESPLIN
FirstName: WILLIAM
MiddleName: FAY
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1055 N 500 W
Address2: ATTN: CREDENTIALING
City: PROVO
State: UT
PostalCode: 846043305
CountryCode: US
TelephoneNumber: 8013548225
FaxNumber: 8014180941
Practice Location
Address1: 736 S 900 E
Address2: SUITE 203
City: ST GEORGE
State: UT
PostalCode: 847907000
CountryCode: US
TelephoneNumber: 4356736131
FaxNumber: 4356738557
Other Information
ProviderEnumerationDate: 05/18/2007
LastUpdateDate: 02/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X8569666-1204UTY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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