Provider Demographics
NPI:1497822621
Name:DEMENT, WILLIAM T (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:DEMENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3318
Mailing Address - Country:US
Mailing Address - Phone:573-686-4151
Mailing Address - Fax:573-778-4699
Practice Address - Street 1:2420 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6122
Practice Address - Country:US
Practice Address - Phone:870-236-9756
Practice Address - Fax:870-236-9356
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-4148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155020001Medicaid
AR5N015Medicare PIN
ARI18797Medicare UPIN