=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730224015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ALOYISUS MCLAUGHLIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 463142 STATE ROAD 200
-----------------------------------------------------
City | YULEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32097-5554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-225-8280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 382 S FLETCHER AVE
-----------------------------------------------------
City | FERNANDINA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32034-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-321-0961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | ME96651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------