Healthcare Provider Details

I. General information

NPI: 1578504429
Provider Name (Legal Business Name): WILLIAM E. GOELLNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OLD CAMP RD STE 192
THE VILLAGES FL
32162-5605
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-5514
  • Fax: 352-753-1276
Mailing address:
  • Phone: 407-447-7105
  • Fax: 407-770-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME30269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: