Basic Information
| Provider Information | |||||||||
| NPI: | 1619255353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCANN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | R. EP T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 TOWN SQUARE PL | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817686730 | ||||||||
| FaxNumber: | 2817686766 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 TOWN SQUARE PL | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817686730 | ||||||||
| FaxNumber: | 2817686766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2011 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | R. EP T. 1087 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
ID Information
| ID | Type | State | Issuer | Description | 1087 | 01 | R. EP T. | OTHER |