Provider Demographics
NPI:1629053665
Name:CAUDILL, WILLIAM HAMPTON II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HAMPTON
Last Name:CAUDILL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 W PARK BLVD
Mailing Address - Street 2:SUITE 306-372
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6208
Mailing Address - Country:US
Mailing Address - Phone:972-381-1251
Mailing Address - Fax:
Practice Address - Street 1:6451 BRENTWOOD STAIR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3200
Practice Address - Country:US
Practice Address - Phone:817-507-1770
Practice Address - Fax:817-507-1771
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7758207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079KWOtherBCBS
TX125540801Medicaid
TX930057454OtherMEDICARE RAILROAD
TX164674701Medicaid
TX85898FOtherBCBS
TX610333Medicare PIN
TXP00233148Medicare PIN
TX85898FOtherBCBS
TX125540801Medicaid