Provider Demographics
NPI:1356447254
Name:ENNIS, WILLIAM J III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:ENNIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7559
Mailing Address - Country:US
Mailing Address - Phone:603-789-9103
Mailing Address - Fax:603-227-7832
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2598
Practice Address - Country:US
Practice Address - Phone:603-789-9103
Practice Address - Fax:603-227-7832
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH9150207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006777Medicaid
NH0109559Y0NH03OtherANTHEM BCBS
NH8060319OtherCIGNA
NHRE3073Medicare ID - Type Unspecified
NH30006777Medicaid