Provider Demographics
NPI:1649255258
Name:HARFORD JR, WILLIAM VANDIVER (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VANDIVER
Last Name:HARFORD JR
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 1:4500 S LANCASTER RD
Mailing Address - Street 2:GASTRO 111B1, DVAMC
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-371-6441
Mailing Address - Fax:214-857-1571
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:GASTRO 111B1, DVAMC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-371-6441
Practice Address - Fax:214-857-1571
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0957207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16598Medicare UPIN
TX8A0068Medicare ID - Type Unspecified