Provider Demographics
NPI:1700374758
Name:VISSER, WILLIAM ROGER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROGER
Last Name:VISSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 MEDICAL PARK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9289
Mailing Address - Country:US
Mailing Address - Phone:804-765-6100
Mailing Address - Fax:804-765-5373
Practice Address - Street 1:40 MEDICAL PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9289
Practice Address - Country:US
Practice Address - Phone:804-765-6100
Practice Address - Fax:804-765-5373
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101278183208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology