Provider Demographics
NPI:1548216757
Name:FUTCH, WILLIAM STEWART JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEWART
Last Name:FUTCH
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 MEDICAL CAMPUS DR NW STE 102
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4093
Practice Address - Country:US
Practice Address - Phone:910-754-5988
Practice Address - Fax:910-754-5989
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601318207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891130JMedicaid
NCF46576Medicare UPIN
NC891130JMedicaid
NC891130JMedicaid
NCP00254847Medicare PIN