Provider Demographics
NPI:1295855823
Name:VINYARD, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:VINYARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:291 NW PEACOCK BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2214
Mailing Address - Country:US
Mailing Address - Phone:772-212-0304
Mailing Address - Fax:772-212-0301
Practice Address - Street 1:291 NW PEACOCK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2214
Practice Address - Country:US
Practice Address - Phone:772-212-0304
Practice Address - Fax:772-212-0301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-05814208600000X
CAA983422086S0122X
FLME1200692086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN