Healthcare Provider Details

I. General information

NPI: 1346246626
Provider Name (Legal Business Name): WILLIAM C L WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

927 MCCULLOUGH AVE
SAN ANTONIO TX
78215-1630
US

IV. Provider business mailing address

927 MCCULLOUGH AVE
SAN ANTONIO TX
78215-1630
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-6896
  • Fax: 210-223-3888
Mailing address:
  • Phone: 210-223-6896
  • Fax: 210-223-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH8897
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH8897
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberH8897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: