Individual
WILLIAM F SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 HAZEL LANE, FARMINGTON, MO, MO 63640
(573) 747-1777
(573) 747-1077
Mailing address
1151 HAZEL LN, FARMINGTON, MO 63640
(573) 747-1777
(571) 747-1077
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036060822
IL
207RC0000X
Cardiovascular Disease Physician
Primary
R7100
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000013185
MEDICARE GROUP PTAN
MO
05
—
1265499347
—
MO
01
—
131850001
MEDICARE PTAN
MO
01
—
1881863009
GROUP NPI
MO
01
—
CI7050
RR GROUP
MO
01
—
P00646568
RR PTAN
MO
01
—
P00847517
RAILROAD MEDICARE
MO
Enumeration date
05/01/2006
Last updated
07/10/2015
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