Provider Demographics
NPI:1629191127
Name:WILLIAM R VIVAS DPM PA
Entity Type:Organization
Organization Name:WILLIAM R VIVAS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-642-5153
Mailing Address - Street 1:330 SW 27TH AVE
Mailing Address - Street 2:SUITE# 408A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2961
Mailing Address - Country:US
Mailing Address - Phone:305-542-5153
Mailing Address - Fax:305-642-5213
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:SUITE# 408A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2961
Practice Address - Country:US
Practice Address - Phone:305-542-5153
Practice Address - Fax:305-642-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1733213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041398400Medicaid
FL87883OtherBCBS
FL041398400Medicaid
FL87883Medicare PIN