Provider Demographics
NPI:1659329555
Name:MCGLATHERY, WILLIAM THOMAS IV (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MCGLATHERY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4207 JAMES CASEY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1193
Mailing Address - Country:US
Mailing Address - Phone:512-447-6096
Mailing Address - Fax:512-447-2247
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1193
Practice Address - Country:US
Practice Address - Phone:512-447-6096
Practice Address - Fax:512-447-2247
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOM3639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190111801Medicaid
TX8W540OtherBCBS
TX8W540OtherBCBS
TX8J2282Medicare ID - Type UnspecifiedMEDICARE