Provider Demographics
NPI:1578627568
Name:MAYFIELD, WILLIAM ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROSS
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2724
Mailing Address - Country:US
Mailing Address - Phone:386-254-4029
Mailing Address - Fax:386-254-4274
Practice Address - Street 1:201 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2724
Practice Address - Country:US
Practice Address - Phone:386-254-4029
Practice Address - Fax:386-254-4274
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063660208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18828OtherBLUE SHIELD
FLD99666Medicare UPIN
FL18828ZMedicare ID - Type Unspecified