MEDICARE: DR. WILLIAM HAMPTON CAUDILL II M.D.

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	207P00000X	Emergency Medicine Physician	J7758	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	930057454	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0079KW	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	85898F	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1629053665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HAMPTON CAUDILL II M.D.

Provider Business Mailing Address
First Line	:	6505 W PARK BLVD
Second Line	:	SUITE 306-372
City	:	PLANO
State	:	TX
Zip	:	75093-6208
Country	:	US
Telephone Number	:	972-381-1251
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 BRENTWOOD STAIR RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3200
Country	:	US
Telephone Number	:	817-507-1770
Fax Number	:	817-507-1771

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/18/2012

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