Provider Demographics
NPI:1972765006
Name:HUMCKE, WILLIAM WALTER JR (RT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WALTER
Last Name:HUMCKE
Suffix:JR
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1112 GOWER ST
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6920
Mailing Address - Country:US
Mailing Address - Phone:803-396-1446
Mailing Address - Fax:
Practice Address - Street 1:1112 GOWER ST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6920
Practice Address - Country:US
Practice Address - Phone:803-396-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3132022471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging