MEDICARE: WILLIAM THOMAS GILES D.O.

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	207Q00000X	Family Medicine Physician	D6269	TX

General Provider Information

NPI Number	:	1609807924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM THOMAS GILES D.O.

Provider Business Mailing Address
First Line	:	9229 LYNDON B JOHNSON FWY
Second Line	:	SUITE 250
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3097
Fax Number	:	972-739-2673

Provider Business Practice Location Address
First Line	:	6100 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3703
Country	:	US
Telephone Number	:	817-237-3321
Fax Number	:	817-237-7970

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/21/2022

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