Provider Demographics
NPI:1922057389
Name:HULL, WILLIAM LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:HULL
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:435 S CRYSTAL ST STE 300
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1506
Practice Address - Country:US
Practice Address - Phone:406-496-3600
Practice Address - Fax:406-496-3677
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8199207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0156604Medicaid
A006OtherTRICARE
ID805387000Medicaid
MTP00328777OtherRAILROAD MEDICARE
S6174OtherBC OF IDAHO
C98262Medicare UPIN