Provider Demographics
NPI:1053341792
Name:EDENFIELD, WILLIAM PERRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PERRY
Last Name:EDENFIELD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10335 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5763
Mailing Address - Country:US
Mailing Address - Phone:262-240-9870
Mailing Address - Fax:262-240-9869
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:803-791-2660
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC20-186922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC186925Medicaid
G76127Medicare UPIN