Provider Demographics
NPI:1912123621
Name:WILLIAM W FOLLETT III MD
Entity Type:Organization
Organization Name:WILLIAM W FOLLETT III MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:FOLLETT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:714-356-5709
Mailing Address - Street 1:PO BOX 220212
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4171 N MESA ST
Practice Address - Street 2:BLDG A SUITE 104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1444
Practice Address - Country:US
Practice Address - Phone:714-356-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F865Medicare ID - Type Unspecified
TXC15639Medicare UPIN