MEDICARE: DR. WILLIAM DAVID CORBETT D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	P00000460	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87207	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1689633182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM DAVID CORBETT D.P.M.

Provider Business Mailing Address
First Line	:	2662 DICK WILSON DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-8723
Country	:	US
Telephone Number	:	941-342-6077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 FLOYD ST
Second Line	:	SUITE C
City	:	SARASOTA
State	:	FL
Zip	:	34239-2931
Country	:	US
Telephone Number	:	941-366-2627
Fax Number	:	941-951-2356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/08/2007

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