MEDICARE: DR. JOSEPH GEORGE WILLIAM DO, MPH

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	208100000X	Physical Medicine & Rehabilitation Physician	3764	TN
2	208VP0000X	Pain Medicine Physician	R7352	TX
3	208VP0000X	Pain Medicine Physician	3764	TN
4	208100000X	Physical Medicine & Rehabilitation Physician	R7352	TX

General Provider Information

NPI Number	:	1972920270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GEORGE WILLIAM DO, MPH

Provider Business Mailing Address
First Line	:	1101 WOLF LAKES DRIVE, SUITE 225
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-3778
Country	:	US
Telephone Number	:	512-324-6722
Fax Number	:	512-324-2574

Provider Business Practice Location Address
First Line	:	1101 WOLF LAKES DR, SUITE 225
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-3778
Country	:	US
Telephone Number	:	512-324-6722
Fax Number	:	512-324-2574

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

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	06/07/2024

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