Basic Information
Provider Information
NPI: 1568442812
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARRICK
FirstName: WILLIAM
MiddleName: H
NamePrefix:  
NameSuffix: III
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4881 NW 8TH AVE
Address2: SUITE 2
City: GAINESVILLE
State: FL
PostalCode: 326054582
CountryCode: US
TelephoneNumber: 3523736338
FaxNumber: 3523736144
Practice Location
Address1: 4343 W NEWBERRY RD
Address2: SUITE 11
City: GAINESVILLE
State: FL
PostalCode: 326072817
CountryCode: US
TelephoneNumber: 3523723471
FaxNumber: 3523752442
Other Information
ProviderEnumerationDate: 01/20/2006
LastUpdateDate: 12/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME35673FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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