Healthcare Provider Details

I. General information

NPI: 1609372853
Provider Name (Legal Business Name): WILLIAM MARSHALL AZKOUL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 JUPITER LAKES BLVD BUILDING 5000, SUITE 105
JUPITER FL
33458
US

IV. Provider business mailing address

210 JUPITER LAKES BLVD BLDG 5000, SUITE 105
JUPITER FL
33458
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-4444
  • Fax:
Mailing address:
  • Phone: 561-748-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301509228
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number78120
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME170971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: