Provider Demographics
NPI:1407998461
Name:MCBROOM, WILLIAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:MCBROOM
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 1:1253 N VON MINDEN ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1262
Mailing Address - Country:US
Mailing Address - Phone:979-968-8493
Mailing Address - Fax:979-968-6388
Practice Address - Street 1:1253 N VON MINDEN ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1262
Practice Address - Country:US
Practice Address - Phone:979-968-8493
Practice Address - Fax:979-968-6388
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE6500OtherSTATE LICENSE
TX139351417Medicaid
TXB24700Medicare UPIN
TX8796N0Medicare ID - Type Unspecified