Provider Demographics
NPI:1972587848
Name:NIELDS, WILLIAM WESSON (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESSON
Last Name:NIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 KETCH CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6331
Mailing Address - Country:US
Mailing Address - Phone:904-923-3484
Mailing Address - Fax:
Practice Address - Street 1:8236 KETCH CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6331
Practice Address - Country:US
Practice Address - Phone:904-923-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89110208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHO185YOtherMEDICARE
FLHO185YMedicare PIN