Provider Demographics
NPI:1710057047
Name:BESTERMANN, WILLIAM HENRY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:BESTERMANN
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:SUITE 5D
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-857-2790
Practice Address - Fax:423-857-2791
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7752174400000X
TNMD41977T207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710057047Medicaid
TN3000587Medicaid
0281780003Medicare PIN
TNP00426227Medicare PIN
TN103I086169Medicare UPIN
D90852Medicare UPIN
TNCA5023Medicare PIN
0281780001Medicare PIN
TN3700592Medicare UPIN
TN3000587Medicare PIN