Provider Demographics
NPI:1255316949
Name:AGERTON, WILLIAM D JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:AGERTON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHINA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2815
Mailing Address - Country:US
Mailing Address - Phone:760-939-4889
Mailing Address - Fax:619-767-7417
Practice Address - Street 1:4814 KING LN
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414
Practice Address - Country:US
Practice Address - Phone:760-382-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH97442083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine