Provider Demographics
NPI:1346817111
Name:DEFOOR, WILLIAM MOORHEAD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MOORHEAD
Last Name:DEFOOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:DEFOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1234 HUFFMAN MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-538-1234
Mailing Address - Fax:336-584-6811
Practice Address - Street 1:1234 HUFFMAN MILL ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-506-1280
Practice Address - Fax:336-584-6811
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC0010-11331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant