Basic Information
| Provider Information | |||||||||
| NPI: | 1558377325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANSS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 N KANSAS ST | ||||||||
| Address2: | STE. 1501 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799011443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155469200 | ||||||||
| FaxNumber: | 9155469800 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 N KANSAS ST | ||||||||
| Address2: | STE. 1501 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799011443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155469200 | ||||||||
| FaxNumber: | 9155469800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K4462 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | K4462 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 33632359 | 05 | NM | MEDICAID | P01251633 | 01 | TX | RAILROAD RETIREMENT MEDICARE | OTHER | 1162018-08 | 05 | TX | MEDICAID | 8DZ191 | 01 | TX | BC/BS OF TEXAS | OTHER |