Provider Demographics
NPI:1194718601
Name:WILLIAM O DEWEESE MD PA
Entity type:Organization
Organization Name:WILLIAM O DEWEESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:DEWEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-971-8101
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
Mailing Address - Country:US
Mailing Address - Phone:813-971-8101
Mailing Address - Fax:813-971-3172
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-971-8101
Practice Address - Fax:813-971-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025687207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29889OtherBCBS
FL270374200Medicaid
FL4129349OtherAETNA PROVIDER NUMBER
FL1508416-002OtherCIGNA
FL270374200Medicaid
FL270374200Medicaid
FLDL264AMedicare PIN