Provider Demographics
NPI:1306991799
Name:DINWIDDIE, WILLIAM COURTENAY JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COURTENAY
Last Name:DINWIDDIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:53 CONLEY STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6817
Mailing Address - Country:US
Mailing Address - Phone:828-550-1314
Mailing Address - Fax:828-255-7623
Practice Address - Street 1:55 BUCKEYE COVE ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716
Practice Address - Country:US
Practice Address - Phone:828-648-0282
Practice Address - Fax:828-648-3479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2001-01194207Q00000X
NC200101194261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E11247Medicare UPIN