Provider Demographics
NPI:1073559738
Name:DE VITO, WILLIAM F (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:DE VITO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2078 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5389
Mailing Address - Country:US
Mailing Address - Phone:928-776-6400
Mailing Address - Fax:855-633-3142
Practice Address - Street 1:2078 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5389
Practice Address - Country:US
Practice Address - Phone:928-776-6400
Practice Address - Fax:855-633-3142
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH73368Medicare UPIN