Provider Demographics
NPI:1386662419
Name:GILES, WILLIAM RUSSELL JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:GILES
Suffix:JR
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:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-713-1582
Mailing Address - Fax:903-713-1579
Practice Address - Street 1:126 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5297
Practice Address - Country:US
Practice Address - Phone:903-713-1582
Practice Address - Fax:903-713-1579
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S5838OtherBLUE CROSS
TX174192802Medicaid
TXP00339673OtherRAILROAD MEDICARE
TX8G7752Medicare PIN
TX8L1585Medicare PIN
TX8S5838OtherBLUE CROSS
TXI27800Medicare UPIN