1790761724 NPI number — WILLIAM P COONEY III MD

Table of content: WILLIAM P COONEY III MD (NPI 1790761724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790761724 NPI number — WILLIAM P COONEY III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COONEY
Provider First Name:
WILLIAM
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790761724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 HOLLY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32963-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 HOLLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32963-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-254-9808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  ME91212 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AF120Z . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00462899 . This is a "MEDICARE RR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 020169000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091017100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6194400001 . This is a "PALMETTO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 53629 . This is a "BLUE CROSS BLUE SHEILD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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