Healthcare Provider Details

I. General information

NPI: 1801891742
Provider Name (Legal Business Name): WILLIAM E. BEATY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

5214 SW 91ST WAY #120
GAINESVILLE FL
32608-4172
US

IV. Provider business mailing address

PO BOX 357703
GAINESVILLE FL
32635-7703
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-5520
  • Fax: 352-331-6323
Mailing address:
  • Phone: 352-331-5520
  • Fax: 352-331-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0003468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: