Healthcare Provider Details

I. General information

NPI: 1548216757
Provider Name (Legal Business Name): WILLIAM STEWART FUTCH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MEDICAL CAMPUS DR NW STE 102
SUPPLY NC
28462-4093
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-5988
  • Fax: 910-754-5989
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9601318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: