Healthcare Provider Details

I. General information

NPI: 1245289768
Provider Name (Legal Business Name): WILLIAM ALEXANDER STEELE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-8159
  • Fax: 321-494-3648
Mailing address:
  • Phone: 321-494-8159
  • Fax: 321-494-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000767A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: