MEDICARE: DR. WILLIAM EDWIN BECKWITH PH.D.

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	103G00000X	Clinical Neuropsychologist	PY4589	FL

General Provider Information

NPI Number	:	1760432678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EDWIN BECKWITH PH.D.

Provider Business Mailing Address
First Line	:	1415 PANTHER LN
Second Line	:	SUTIE 239
City	:	NAPLES
State	:	FL
Zip	:	34109-7874
Country	:	US
Telephone Number	:	239-263-0966
Fax Number	:	239-591-6227

Provider Business Practice Location Address
First Line	:	1415 PANTHER LN
Second Line	:	SUTIE 239
City	:	NAPLES
State	:	FL
Zip	:	34109-7874
Country	:	US
Telephone Number	:	239-263-0966
Fax Number	:	239-591-6227

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/21/2008

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