Provider Demographics
NPI:1275746034
Name:PRIVITERA, WILLIAM JOHN I (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:PRIVITERA
Suffix:I
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 1:2600 VIA FORTUNA
Mailing Address - Street 2:#410
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7992
Mailing Address - Country:US
Mailing Address - Phone:512-327-8500
Mailing Address - Fax:512-327-1381
Practice Address - Street 1:2600 VIA FORTUNA
Practice Address - Street 2:#410
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7992
Practice Address - Country:US
Practice Address - Phone:512-327-8500
Practice Address - Fax:512-327-1381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ22622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry