Individual
DR. WILLIAM R WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 PENNSYLVANIA AVE, SUITE 200, FORT WORTH, TX 76104-2158
(817) 332-9957
(817) 336-3130
Mailing address
1325 PENNSYLVANIA AVE, SUITE 200, FORT WORTH, TX 76104-2158
(817) 332-9957
(817) 336-3130
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L8231
TX
2086S0127X
Trauma Surgery Physician
L8231
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176760001
—
TX
05
—
176760002
—
TX
01
—
1D7580
CTC - BCBS
—
Enumeration date
05/15/2006
Last updated
08/11/2020
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