Provider Demographics
NPI:1134104318
Name:FADER, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:FADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7017 S STAPLES ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5507
Mailing Address - Country:US
Mailing Address - Phone:361-994-7255
Mailing Address - Fax:361-994-7740
Practice Address - Street 1:7017 S STAPLES ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5507
Practice Address - Country:US
Practice Address - Phone:361-994-7255
Practice Address - Fax:361-994-7740
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXA3035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121271404Medicaid
TX121271401Medicaid
TX121271404Medicaid