Provider Demographics
NPI:1346246626
Name:WU, WILLIAM C L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C L
Last Name:WU
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 1:927 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1630
Mailing Address - Country:US
Mailing Address - Phone:210-223-6896
Mailing Address - Fax:210-223-3888
Practice Address - Street 1:927 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1630
Practice Address - Country:US
Practice Address - Phone:210-223-6896
Practice Address - Fax:210-223-3888
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-03-29
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXH8897174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128253506Medicaid
TX128253507Medicaid
TX060047582OtherRAILROAD MEDICARE
TX84850GOtherBCBS
TX128253504Medicaid
TX8CK583OtherBCBS
TX8CU338OtherBCBS
TX060047582OtherRAILROAD MEDICARE
TX128253507Medicaid
TXTXB126188Medicare PIN
TX8CU338OtherBCBS