Provider Demographics
NPI:1275528002
Name:O'MALLEY, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2711
Mailing Address - Country:US
Mailing Address - Phone:713-664-5890
Mailing Address - Fax:
Practice Address - Street 1:10655 STEEPLETOP DR
Practice Address - Street 2:CYPRESS FAIRBANKS ER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4222
Practice Address - Country:US
Practice Address - Phone:281-897-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8075207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93576Medicare UPIN