Healthcare Provider Details

I. General information

NPI: 1053544437
Provider Name (Legal Business Name): WILLIAM ROBERT MCCAFFERTY III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

V. Phone/Fax

Practice location:
  • Phone: 610-627-3690
  • Fax: 610-627-3684
Mailing address:
  • Phone: 610-627-3690
  • Fax: 610-627-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO 2271
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016474
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS016474
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: