Provider Demographics
NPI:1154364537
Name:FEARS, WILLIAM BURTON (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BURTON
Last Name:FEARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4914
Mailing Address - Country:US
Mailing Address - Phone:972-296-5557
Mailing Address - Fax:972-296-5592
Practice Address - Street 1:1014 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4914
Practice Address - Country:US
Practice Address - Phone:972-296-5557
Practice Address - Fax:972-296-5592
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6929207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033381702Medicaid
TX033381705Medicaid
TX033381708Medicaid
TXB22658Medicare UPIN
TX8J2464Medicare ID - Type Unspecified
TXTXB123543Medicare PIN
TXTXB122222Medicare PIN
TXTXB121809Medicare PIN
TX033381708Medicaid