Provider Demographics
NPI:1477943835
Name:EARLY, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:EARLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6479
Mailing Address - Country:US
Mailing Address - Phone:407-852-5800
Mailing Address - Fax:
Practice Address - Street 1:2989 W STATE ROAD 434
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4463
Practice Address - Country:US
Practice Address - Phone:407-852-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4290237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010430500Medicaid