Healthcare Provider Details

I. General information

NPI: 1235131657
Provider Name (Legal Business Name): WILLIAM WAINWRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 270
JACKSONVILLE BEACH FL
32250-3258
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-7147
  • Fax: 904-241-5492
Mailing address:
  • Phone: 904-720-0799
  • Fax: 904-241-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31677
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME31677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: