Basic Information
Provider Information
NPI: 1740574300
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOWNSEND
FirstName: WILLIAM
MiddleName: LEE
NamePrefix: MR.
NameSuffix:  
Credential: ATP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2910 SOUTH PADRE ISLAND DRIVE
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 78415
CountryCode: US
TelephoneNumber: 5124584589
FaxNumber: 5122060955
Practice Location
Address1: 2910 SOUTH PADRE ISLAND DRIVE
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 78415
CountryCode: US
TelephoneNumber: 5124584589
FaxNumber: 5122060955
Other Information
ProviderEnumerationDate: 06/01/2011
LastUpdateDate: 06/01/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
247200000XATP4683TXY Technologists, Technicians & Other Technical Service ProvidersTechnician, Other 

No ID Information.


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