Healthcare Provider Details

I. General information

NPI: 1851592075
Provider Name (Legal Business Name): WILLIAM S CANTWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST EMCARE
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N SUITE 650
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 727-533-8707
  • Fax: 727-507-3618
Mailing address:
  • Phone: 727-533-8707
  • Fax: 727-507-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.201136
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD.201136
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberN3533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: