Healthcare Provider Details

I. General information

NPI: 1134112865
Provider Name (Legal Business Name): WILLIAM RUSSELL FELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 22ND #100
LUBBOCK TX
79410
US

IV. Provider business mailing address

3802 22ND #100
LUBBOCK TX
79410
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-5331
  • Fax: 806-792-9417
Mailing address:
  • Phone: 806-792-5331
  • Fax: 806-792-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4303
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberJ5090
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: