Provider Demographics
NPI:1801936141
Name:WILLIAM RISK, MD, PA
Entity type:Organization
Organization Name:WILLIAM RISK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RISK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-284-7499
Mailing Address - Street 1:809 W HARWOOD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-6233
Mailing Address - Country:US
Mailing Address - Phone:817-284-7499
Mailing Address - Fax:817-284-4262
Practice Address - Street 1:809 W HARWOOD RD STE 204
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-6233
Practice Address - Country:US
Practice Address - Phone:817-284-7499
Practice Address - Fax:817-284-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8419208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032402201Medicaid
TX00C755OtherBCBS
TX032402201Medicaid
TX00C755OtherBCBS