Provider Demographics
NPI:1558740019
Name:AMADOR, WILLIAM JENNINGS (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JENNINGS
Last Name:AMADOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIA BERTOLISSI, 17C
Mailing Address - Street 2:APT A8
Mailing Address - City:SACILE
Mailing Address - State:PORDENONE
Mailing Address - Zip Code:33077
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVIANO HEALTH AND WELLNESS CENTER
Practice Address - Street 2:AVIANO AIR BASE
Practice Address - City:AVIANO
Practice Address - State:PORDENONE
Practice Address - Zip Code:33081
Practice Address - Country:IT
Practice Address - Phone:314-632-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016301390200000X
PAOS019208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program