Provider Demographics
NPI:1336105220
Name:ANTHONY, WILLIAM EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:ANTHONY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:311 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:704-865-7096
Mailing Address - Fax:704-853-3735
Practice Address - Street 1:311 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052
Practice Address - Country:US
Practice Address - Phone:704-865-7096
Practice Address - Fax:704-853-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911584Medicaid
NC8911584Medicaid
E83969Medicare UPIN