Provider Demographics
NPI:1265467237
Name:MCWHORTER, WILLIAM RYAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYAN
Last Name:MCWHORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:MCWHORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:239 MITYLENE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3547
Mailing Address - Country:US
Mailing Address - Phone:334-819-8190
Mailing Address - Fax:334-819-8195
Practice Address - Street 1:239 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3547
Practice Address - Country:US
Practice Address - Phone:334-819-8190
Practice Address - Fax:334-819-8195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51557824Medicare UPIN