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General NPI Number Information
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NPI Number | 1376591065
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Entity Type | Individual
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Provider Name | WILLIAM C COULTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 12600 CREEKSIDE LN STE 6
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City | FORT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 239-343-9219
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Fax | 239-343-9221
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-9219
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Fax | 239-343-9221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA436
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA436
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA436
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License Number State | KY
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