Provider Demographics
NPI:1487642880
Name:WILLIAM M LETSON JR MD PA
Entity Type:Organization
Organization Name:WILLIAM M LETSON JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:LETSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:941-497-7700
Mailing Address - Street 1:1988 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5001
Mailing Address - Country:US
Mailing Address - Phone:941-497-7700
Mailing Address - Fax:941-493-3703
Practice Address - Street 1:1988 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5001
Practice Address - Country:US
Practice Address - Phone:941-497-7700
Practice Address - Fax:941-493-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49074208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11402OtherBCBS OF FL
FLK7116Medicare ID - Type Unspecified
FL11402OtherBCBS OF FL