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NPI Code Detail

MEDICARE: DR. W MICHAEL AVERITT D.O.

MEDICARE: DR. W MICHAEL AVERITT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianH9764TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
186J260OTHERTXBLUE SHIELD

General Provider Information

NPI Number : 1033179304
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. W MICHAEL AVERITT D.O.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 3801 SCOTT AND WHITE DR
Second Line :
City : KILLEEN
State : TX
Zip : 76543-5252
Country : US
Telephone Number : 254-680-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 04/10/2020

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