Provider Demographics
NPI:1194704379
Name:FUTRELL, THOMAS WALTER (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WALTER
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:907 GOOSE CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2352
Mailing Address - Country:US
Mailing Address - Phone:540-213-2240
Mailing Address - Fax:540-213-2242
Practice Address - Street 1:907 GOOSE CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2352
Practice Address - Country:US
Practice Address - Phone:540-213-2240
Practice Address - Fax:540-213-2242
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058590207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006500056OtherVA PREMIER
VA371424479OtherVA HEALTH NETWORK
VA24986OtherSENTARA
VA259524OtherANTHEM BLUE CROSS
VA371424479OtherMAMSI
VA040017242OtherRAILROAD MEDICARE
VA371424479OtherVALLEY HEALTH PLAN
VA006500056Medicaid
VA157902OtherSOUTHERN HEALTH
VA371424479OtherUNITED HEALTHCARE
VA2689876008OtherCIGNA
VA259524OtherANTHEM BLUE CROSS
VA040017242OtherRAILROAD MEDICARE