Healthcare Provider Details

I. General information

NPI: 1053522052
Provider Name (Legal Business Name): WILLIAM SAMUEL HAVRON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W UNDERWOOD ST STE 200
ORLANDO FL
32806-1122
US

IV. Provider business mailing address

77 W UNDERWOOD ST STE 200
ORLANDO FL
32806-1122
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6884
  • Fax: 407-245-7059
Mailing address:
  • Phone: 407-649-6884
  • Fax: 407-245-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME121404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: