Provider Demographics
NPI:1659462141
Name:POOL, WILLIAM JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:POOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-6155
Mailing Address - Country:US
Mailing Address - Phone:817-484-2707
Mailing Address - Fax:817-484-2706
Practice Address - Street 1:611 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-6155
Practice Address - Country:US
Practice Address - Phone:817-484-2707
Practice Address - Fax:817-484-2706
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149673OtherMEDICARE PTAN