Provider Demographics
NPI:1962528596
Name:ISAACS, BILL CALVIN (MD)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:CALVIN
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:C
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:817 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014
Mailing Address - Country:US
Mailing Address - Phone:806-323-9307
Mailing Address - Fax:
Practice Address - Street 1:817 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014
Practice Address - Country:US
Practice Address - Phone:806-323-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033060701Medicaid
B23708Medicare UPIN
00EX54Medicare ID - Type Unspecified