Provider Demographics
NPI:1629077482
Name:OAKLEY, WILLIAM ENNIS JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ENNIS
Last Name:OAKLEY
Suffix:JR
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 1:19015 US HIGHWAY 441
Mailing Address - Street 2:CENTRA CARE
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6708
Mailing Address - Country:US
Mailing Address - Phone:352-383-6479
Mailing Address - Fax:
Practice Address - Street 1:19015 US HIGHWAY 441
Practice Address - Street 2:CENTRA CARE
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6708
Practice Address - Country:US
Practice Address - Phone:352-383-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11791Medicare UPIN
FL80171ZMedicare ID - Type Unspecified