Provider Demographics
NPI:1992793673
Name:SMALL, WILLIAM CURTIS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CURTIS
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:CURTIS
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1213 15TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3800
Mailing Address - Country:US
Mailing Address - Phone:701-774-7400
Mailing Address - Fax:701-774-7482
Practice Address - Street 1:1213 15TH AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3800
Practice Address - Country:US
Practice Address - Phone:701-774-7400
Practice Address - Fax:701-774-7482
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE33925Medicare UPIN