Basic Information
| Provider Information | |||||||||
| NPI: | 1063413953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARRON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4189 | ||||||||
| Address2: | AUSTIN HEART | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787654189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064300 | ||||||||
| FaxNumber: | 5122064350 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 N LAMAR BLVD | ||||||||
| Address2: | STE 300, AUSTIN HEART PA | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787564080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122063600 | ||||||||
| FaxNumber: | 5124542581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | D4218 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 048109 | 01 | GREAT WEST | OTHER | 78756-A018 | 01 | CHAMPUS / TRICARE | OTHER | 122435 | 01 | USA MANAGED CARE | OTHER | 4126287 | 01 | AETNA / TRS | OTHER | 829045 | 01 | TX | BC / BS | OTHER | 56082 | 01 | TX | FIRST HEALTH | OTHER |