Provider Demographics
NPI:1245239359
Name:SURBER, WILLIAM E (M D)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:SURBER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 LEWIS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9383
Mailing Address - Country:US
Mailing Address - Phone:903-739-2244
Mailing Address - Fax:903-739-2246
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:STE. 101
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9383
Practice Address - Country:US
Practice Address - Phone:903-739-2244
Practice Address - Fax:903-739-2246
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-05-24
Deactivation Date:2013-05-08
Deactivation Code:
Reactivation Date:2013-05-24
Provider Licenses
StateLicense IDTaxonomies
TXG6629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126498802Medicaid
TX126498802Medicaid
TX00A14VMedicare PIN