Healthcare Provider Details

I. General information

NPI: 1982633871
Provider Name (Legal Business Name): WILLIAM O. KEARSE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 INDIANA AVE
LUBBOCK TX
79413-5740
US

IV. Provider business mailing address

PO BOX 16304
LUBBOCK TX
79490-6304
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-6868
  • Fax: 806-771-7444
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ9933
License Number StateTX

VIII. Authorized Official

Name: MRS. YVETTE HINOJOSA
Title or Position: DIRECTOR, MANAGED CARE
Credential:
Phone: 806-761-0333