Provider Demographics
NPI:1356305130
Name:CLAUSON, WILLIAM ALEX SR (IDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALEX
Last Name:CLAUSON
Suffix:SR
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:CLAUSON
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:9425 PHILLIP AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-3329
Mailing Address - Country:US
Mailing Address - Phone:757-587-1104
Mailing Address - Fax:
Practice Address - Street 1:USS ROSS DDG 71
Practice Address - Street 2:FPO AE 09586
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-444-2608
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman