Healthcare Provider Details

I. General information

NPI: 1730444068
Provider Name (Legal Business Name): WILLILAM L INGHAM HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E BAY DR SUITE G
LARGO FL
33770-2532
US

IV. Provider business mailing address

800 E BAY DR SUITE G
LARGO FL
33770-2532
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-8521
  • Fax: 727-584-1973
Mailing address:
  • Phone: 727-585-8521
  • Fax: 727-584-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0002235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: