Provider Demographics
NPI:1194771857
Name:DRIEBE, WILLIAM T JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:DRIEBE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:THOMAS
Other - Last Name:DRIEBE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-846-2100
Practice Address - Fax:352-392-8554
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42592207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040756900Medicaid
FL01381YMedicare PIN
FL01381WMedicare PIN
FL040756900Medicaid