Provider Demographics
NPI:1649475435
Name:IMMEL, WILLIAM MARK (ND)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARK
Last Name:IMMEL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:MARK
Other - Last Name:IMMEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:PO BOX 2746
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0165
Mailing Address - Country:US
Mailing Address - Phone:541-902-8860
Mailing Address - Fax:541-902-8860
Practice Address - Street 1:1234 RHODODENDRON DR
Practice Address - Street 2:SUITE 1-B
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7406
Practice Address - Country:US
Practice Address - Phone:541-902-8860
Practice Address - Fax:541-902-8860
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR686175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath