Provider Demographics
NPI:1306819032
Name:WESTBROOK, BILLY B (DPM)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:B
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5718
Mailing Address - Country:US
Mailing Address - Phone:903-758-4468
Mailing Address - Fax:903-758-5056
Practice Address - Street 1:2828 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5718
Practice Address - Country:US
Practice Address - Phone:903-758-4468
Practice Address - Fax:903-758-5056
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX0578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092751901Medicaid
TX8AJ312OtherBLUE CROSS BLUE SHIELD
TX092751902Medicaid
TN480928621OtherMEDICARE RAILROAD
TX751523800OtherIRS INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER
TX480001643OtherMEDICARE RAILROAD
TXT16559Medicare UPIN
TX00AL37Medicare PIN
TN480928621OtherMEDICARE RAILROAD