Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | H2595 | TX |
NPI | 1013911072 |
---|---|
Provider Name | Dr. William Wynn Mcmullen |
First Address | Webster, TX 77598-4367 |
Second Address | Webster, TX 77598-4367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 13/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139674913 | (05) | TX |
E45987 | (02) | TX |