Provider Demographics
NPI:1154337657
Name:MCLAY, WILLIAM EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:MCLAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 S VOLUSIA AVE
Mailing Address - Street 2:SUITE C4
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763
Mailing Address - Country:US
Mailing Address - Phone:386-774-2085
Mailing Address - Fax:386-775-1020
Practice Address - Street 1:2445 S VOLUSIA AVE
Practice Address - Street 2:SUITE C4
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7626
Practice Address - Country:US
Practice Address - Phone:386-774-2085
Practice Address - Fax:386-775-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1384213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041140000Medicaid
FL0993400001Medicare NSC
FL041140000Medicaid