Provider Demographics
NPI:1386621308
Name:SHOWS, WILLIAM DEREK (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DEREK
Last Name:SHOWS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:DEREK
Other - Last Name:SHOWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12 UPCHURCH CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5629
Mailing Address - Country:US
Mailing Address - Phone:919-490-0883
Mailing Address - Fax:919-403-3437
Practice Address - Street 1:12 UPCHURCH CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5629
Practice Address - Country:US
Practice Address - Phone:919-490-0883
Practice Address - Fax:919-403-3437
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0310TOtherBCBS PROVIDER NKUMBER
NC2811187AMedicare ID - Type UnspecifiedPROVIDER NUMBER