Provider Demographics
NPI:1598799447
Name:STODDARD, WILLIAM R JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:STODDARD
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 1:124 VERDAE BLVD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-271-9780
Mailing Address - Fax:864-271-9785
Practice Address - Street 1:124 VERDAE BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-271-9780
Practice Address - Fax:864-271-9785
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC067537Medicaid
SCGP0135Medicaid
SCC607223102Medicare ID - Type Unspecified
C60722Medicare UPIN