Healthcare Provider Details

I. General information

NPI: 1962446500
Provider Name (Legal Business Name): WILLIAM M HAMMESFAHR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CR 466 STE 207 D
LADY LAKE FL
32159
US

IV. Provider business mailing address

19740 GULF BOULEVARD
REDINGTON SHORES FL
33708-1146
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-5322
  • Fax:
Mailing address:
  • Phone: 352-217-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME 52212
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberME52212
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME52212
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME52212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: