Provider Demographics
NPI:1124046701
Name:UMSTATTD, WILLIAM ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:UMSTATTD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3008 DAWN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2821
Mailing Address - Country:US
Mailing Address - Phone:512-863-4596
Mailing Address - Fax:512-863-4676
Practice Address - Street 1:3008 DAWN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2821
Practice Address - Country:US
Practice Address - Phone:512-863-4596
Practice Address - Fax:512-863-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF4623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE38865Medicare UPIN
TX00MP19Medicare ID - Type UnspecifiedPART B MEDICARE