Healthcare Provider Details

I. General information

NPI: 1194718601
Provider Name (Legal Business Name): WILLIAM O DEWEESE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 BRUCE B DOWNS BLVD SUITE 403
TAMPA FL
33613-3946
US

IV. Provider business mailing address

13801 BRUCE B DOWNS BLVD SUITE 403
TAMPA FL
33613-3946
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-8101
  • Fax: 813-971-3172
Mailing address:
  • Phone: 813-971-8101
  • Fax: 813-971-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0025687
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM O DEWEESE
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 813-971-8101