Provider Demographics
NPI:1578623070
Name:FINCKE, WILLIAM X (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:X
Last Name:FINCKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 PAVAROTTI TER
Mailing Address - Street 2:#103
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3372
Mailing Address - Country:US
Mailing Address - Phone:561-740-0202
Mailing Address - Fax:
Practice Address - Street 1:9904 PAVAROTTI TER
Practice Address - Street 2:#103
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3372
Practice Address - Country:US
Practice Address - Phone:561-740-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3245363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5299YMedicare ID - Type Unspecified
FLS30336Medicare UPIN