Provider Demographics
NPI:1891732855
Name:FUTRELL, J WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:WILLIAM
Last Name:FUTRELL
Suffix:
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 1:1 SWEET WATER LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1900
Mailing Address - Country:US
Mailing Address - Phone:412-963-6976
Mailing Address - Fax:
Practice Address - Street 1:1 SWEET WATER LN
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-1900
Practice Address - Country:US
Practice Address - Phone:412-963-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022966E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100553OtherUPMC HEALTH PLAN
PAC31366OtherHEALTH AMERICA
PAFU 136524OtherKEYSTONE
PA0006825190001Medicaid
PA1009979OtherGATEWAY
PA1423303OtherCIGNA
PAFU 136524OtherKEYSTONE
PA136524Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER