Provider Demographics
NPI:1811939184
Name:WILLIAM JUSTUS HEAD MD PA
Entity type:Organization
Organization Name:WILLIAM JUSTUS HEAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JUSTUS
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-4533
Mailing Address - Street 1:5111 N 10TH ST
Mailing Address - Street 2:PMB 210
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2835
Mailing Address - Country:US
Mailing Address - Phone:956-631-4533
Mailing Address - Fax:956-631-4335
Practice Address - Street 1:605 E VIOLET AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2481
Practice Address - Country:US
Practice Address - Phone:956-631-4533
Practice Address - Fax:956-631-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166220701Medicaid
TX166220701Medicaid
DD7474Medicare PIN