Provider Demographics
NPI:1063579076
Name:DWORET, WILLIAM EMERSON (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EMERSON
Last Name:DWORET
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-0143
Mailing Address - Country:US
Mailing Address - Phone:774-316-7290
Mailing Address - Fax:774-316-7291
Practice Address - Street 1:21 BREWSTER CROSS RD UNIT C
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3339
Practice Address - Country:US
Practice Address - Phone:774-316-7290
Practice Address - Fax:774-316-7291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS744207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0096AMedicare ID - Type Unspecified
FLA58643Medicare UPIN