Provider Demographics
NPI:1194765461
Name:ALLRED, WILLIAM STANTON
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STANTON
Last Name:ALLRED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WESTPARK WAY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040
Mailing Address - Country:US
Mailing Address - Phone:817-354-7094
Mailing Address - Fax:817-358-1084
Practice Address - Street 1:311 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040
Practice Address - Country:US
Practice Address - Phone:817-354-7094
Practice Address - Fax:817-358-1084
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00ET01Medicare PIN
T11921Medicare UPIN
TX4313180001Medicare NSC