Provider Demographics
NPI:1063500692
Name:NAMEN, WILLIAM J II (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:NAMEN
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9310 OLD KINGS RD S
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6152
Mailing Address - Country:US
Mailing Address - Phone:904-636-9197
Mailing Address - Fax:904-636-9282
Practice Address - Street 1:1351 13TH AVENUE SOUTH
Practice Address - Street 2:SUITE 110
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-636-9197
Practice Address - Fax:904-636-9282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2208213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65319AMedicare ID - Type Unspecified
FLU46941Medicare UPIN
FL4044550001Medicare NSC
FL65319YMedicare PIN