Provider Demographics
NPI:1073506929
Name:MCCARTY, WILLIAM KELLY (DO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KELLY
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:2105 ACADEMY CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1658
Mailing Address - Country:US
Mailing Address - Phone:719-591-2444
Mailing Address - Fax:719-591-2484
Practice Address - Street 1:2105 ACADEMY CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1658
Practice Address - Country:US
Practice Address - Phone:719-591-2444
Practice Address - Fax:719-591-2484
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO29443207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01294438Medicaid
C6552Medicare PIN
A67372Medicare UPIN