Provider Demographics
NPI:1164629168
Name:ANTON, WILLIAM DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:ANTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15961 N FLORIDA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-8101
Mailing Address - Country:US
Mailing Address - Phone:813-961-7544
Mailing Address - Fax:
Practice Address - Street 1:15961 N FLORIDA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-8101
Practice Address - Country:US
Practice Address - Phone:813-961-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical