Healthcare Provider Details

I. General information

NPI: 1114906195
Provider Name (Legal Business Name): WILLIAM FRANCIS FOODY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL STE 105
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-9557
  • Fax: 904-829-9125
Mailing address:
  • Phone: 904-398-3262
  • Fax: 904-265-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22982
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM3548
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME107451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: