MEDICARE: DR. WILLIAM L OVERDYKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	014596	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200016529	OTHER	LA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1053315846	OTHER	LA	GROUP NPI NUMBER

General Provider Information

NPI Number	:	1295739001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM L OVERDYKE MD

Provider Business Mailing Address
First Line	:	1500 LINE AVENUE
Second Line	:	SUITE 100
City	:	SHREVEPORT
State	:	LA
Zip	:	71101
Country	:	US
Telephone Number	:	318-635-3052
Fax Number	:	318-635-3072

Provider Business Practice Location Address
First Line	:	1500 LINE AVENUE
Second Line	:	SUITE 100
City	:	SHREVEPORT
State	:	LA
Zip	:	71101
Country	:	US
Telephone Number	:	318-635-3052
Fax Number	:	318-635-3072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/10/2009

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