Healthcare Provider Details

I. General information

NPI: 1063500692
Provider Name (Legal Business Name): WILLIAM J NAMEN II D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 13TH AVENUE SOUTH SUITE 110
JACKSONVILLE BEACH FL
32250
US

IV. Provider business mailing address

9310 OLD KINGS RD S SUITE 1201
JACKSONVILLE FL
32257-6152
US

V. Phone/Fax

Practice location:
  • Phone: 904-636-9197
  • Fax: 904-636-9282
Mailing address:
  • Phone: 904-636-9197
  • Fax: 904-636-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: