Provider Demographics
NPI:1427166503
Name:DENNIS, WILLIAM MATTEW (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MATTEW
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:M
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6009 PACIFIC WAY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4409
Mailing Address - Country:US
Mailing Address - Phone:361-658-4710
Mailing Address - Fax:361-579-1254
Practice Address - Street 1:3301 SOUTH ALAMEDA
Practice Address - Street 2:SUITE 201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1820
Practice Address - Country:US
Practice Address - Phone:361-658-4710
Practice Address - Fax:361-857-8321
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128651007Medicaid
C15184Medicare UPIN
TX87595KMedicare ID - Type Unspecified