Basic Information
Provider Information
NPI: 1619908050
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLOOD
FirstName: WILLIAM
MiddleName: L.
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX PH
Address2:  
City: CHINLE
State: AZ
PostalCode: 865038000
CountryCode: US
TelephoneNumber: 9286747166
FaxNumber: 9286747705
Practice Location
Address1: HWY 191 & HOSPITAL ROAD
Address2: CCHCF
City: CHINLE
State: AZ
PostalCode: 86503
CountryCode: US
TelephoneNumber: 9286747166
FaxNumber: 9286747705
Other Information
ProviderEnumerationDate: 07/05/2006
LastUpdateDate: 03/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X18789COY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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