Provider Demographics
NPI:1508802877
Name:HEAD, WILLIAM JUSTUS III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JUSTUS
Last Name:HEAD
Suffix:III
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 1:5111 N 10TH ST
Mailing Address - Street 2:PMB 210
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2835
Mailing Address - Country:US
Mailing Address - Phone:956-631-4533
Mailing Address - Fax:956-631-4335
Practice Address - Street 1:605 E VIOLET AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2481
Practice Address - Country:US
Practice Address - Phone:956-631-4533
Practice Address - Fax:956-631-4335
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135476309Medicaid
TX0093NAOtherBLUE CROSS/SHIELD
F6730Medicare UPIN
TX0093NAOtherBLUE CROSS/SHIELD