MEDICARE: WILLIAM K BOTT M.D.

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	207X00000X	Orthopaedic Surgery Physician	ME00033760	FL

General Provider Information

NPI Number	:	1821073362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM K BOTT M.D.

Provider Business Mailing Address
First Line	:	2080 CHILD ST
Second Line	:	NAVAL HOSPITAL JACKSONVILLE--ORTHO DEPT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-7366
Fax Number	:	904-542-7051

Provider Business Practice Location Address
First Line	:	2080 CHILD ST
Second Line	:	NAVAL HOSPITAL JACKSONVILLE--ORTHO DEPT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-7366
Fax Number	:	904-542-7051

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2007

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