Provider Demographics
NPI:1578899555
Name:MAHAN, WILLIAM BARTON (HAS-BC 1808)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BARTON
Last Name:MAHAN
Suffix:
Gender:M
Credentials:HAS-BC 1808
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 US HIGHWAY 441
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7237
Mailing Address - Country:US
Mailing Address - Phone:352-360-0023
Mailing Address - Fax:352-360-0013
Practice Address - Street 1:10601 US HIGHWAY 441 STE E1
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7240
Practice Address - Country:US
Practice Address - Phone:352-360-0023
Practice Address - Fax:352-360-0013
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL264554716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist