Provider Demographics
NPI:1093777625
Name:RESSEGUIE, WILLIAM (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RESSEGUIE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-978-9255
Mailing Address - Fax:602-230-9350
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-978-9255
Practice Address - Fax:602-230-9350
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P47080Medicare UPIN