Healthcare Provider Details

I. General information

NPI: 1316906670
Provider Name (Legal Business Name): WILLIAM KENNETH STATZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST BAYNE-JONES ACH
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

1585 3RD ST BAYNE-JONES ACH
FORT POLK LA
71459-5102
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3926
  • Fax: 337-531-3050
Mailing address:
  • Phone: 337-531-3926
  • Fax: 337-531-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number176751
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberOS 9414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: