Healthcare Provider Details

I. General information

NPI: 1801834015
Provider Name (Legal Business Name): WILLIAM JAMES WILEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 LUCAYA DR
TAMPA FL
33647-3326
US

IV. Provider business mailing address

10506 LUCAYA DR
TAMPA FL
33647-3326
US

V. Phone/Fax

Practice location:
  • Phone: 813-973-8560
  • Fax: 813-973-8560
Mailing address:
  • Phone: 813-973-8560
  • Fax: 813-973-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: