Provider Demographics
NPI:1972844314
Name:LAU, WILLIAM JOSEPH III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:LAU
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTHERN ARIZONA VA HEALTH CARE SYSTEM
Mailing Address - Street 2:3601 S. 6TH AVE., 7-11A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-629-1814
Mailing Address - Fax:520-629-1779
Practice Address - Street 1:SOUTHERN ARIZONA VA HEALTH CARE SYSTEM
Practice Address - Street 2:3601 S. 6TH AVE., 7-11A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-629-1814
Practice Address - Fax:520-629-1779
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant