Provider Demographics
NPI:1063430460
Name:HOUCK, WILLIAM STOKES III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STOKES
Last Name:HOUCK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5060
Mailing Address - Fax:704-316-5069
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-316-5060
Practice Address - Fax:704-316-5069
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC97009872080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891053VMedicaid
SCN00987Medicaid
NC2234962HMedicare PIN
NCF99732Medicare UPIN
SCN00987Medicaid