Provider Demographics
NPI:1447260963
Name:REILLY, WILLIAM G (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760
Mailing Address - Country:US
Mailing Address - Phone:432-332-2663
Mailing Address - Fax:432-337-0910
Practice Address - Street 1:1340 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4724
Practice Address - Country:US
Practice Address - Phone:432-332-2663
Practice Address - Fax:432-337-0910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2755207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181001200OtherDEPT OF LABOR
TX110400202Medicaid
TX5630582OtherAETNA
TX1222324100OtherSOUTHWEST LIFE HEALTH
TX83550GOtherBCBS
NM00026732Medicaid
TXMDJ2755OtherWORKMEN COMPENSATION
TX200033319OtherRAILROAD MCR
TX83550GOtherBCBS
TX1222324100OtherSOUTHWEST LIFE HEALTH