Healthcare Provider Details

I. General information

NPI: 1629053665
Provider Name (Legal Business Name): WILLIAM HAMPTON CAUDILL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 BRENTWOOD STAIR RD SUITE 200
FORT WORTH TX
76112-3200
US

IV. Provider business mailing address

6505 W PARK BLVD SUITE 306-372
PLANO TX
75093-6208
US

V. Phone/Fax

Practice location:
  • Phone: 817-507-1770
  • Fax: 817-507-1771
Mailing address:
  • Phone: 972-381-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ7758
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: