Basic Information
| Provider Information | |||||||||
| NPI: | 1598747826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULVER | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1627 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805384209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706630135 | ||||||||
| FaxNumber: | 9704611422 | ||||||||
| Practice Location | |||||||||
| Address1: | 2923 GINNALA DR | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805382702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706696660 | ||||||||
| FaxNumber: | 9706691099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0001X | 18320 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical & Laboratory Immunology | 207RA0201X | 18320 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 01183201 | 05 | CO | MEDICAID |