Provider Demographics
NPI:1679571319
Name:NOVELLI, WILLIAM JOSEPH JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:NOVELLI
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7807
Mailing Address - Country:US
Mailing Address - Phone:409-722-9355
Mailing Address - Fax:409-420-1002
Practice Address - Street 1:1509 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7807
Practice Address - Country:US
Practice Address - Phone:409-722-9355
Practice Address - Fax:409-420-1002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA40591207R00000X
TXF9887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131541807Medicaid
TX8C1060Medicare PIN
TXC19953Medicare UPIN