Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | Q4201 | TX |
NPI | 1093786931 |
---|---|
Provider Name | Dr. William T Mccullough |
First Address | Allen, TX 75013-5292 |
Second Address | Allen, TX 75013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 17/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125193 | (02) | TX |
34876700 | (05) | WI |