Provider Demographics
NPI:1639175060
Name:CORIN, WILLIAM JEFFREY (MDFACC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:CORIN
Suffix:
Gender:M
Credentials:MDFACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4521
Mailing Address - Country:US
Mailing Address - Phone:941-492-5666
Mailing Address - Fax:941-497-2331
Practice Address - Street 1:1225 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4521
Practice Address - Country:US
Practice Address - Phone:941-492-5666
Practice Address - Fax:941-497-2331
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062167207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3736547000Medicaid
FL18929Medicare ID - Type Unspecified
FLE67317Medicare UPIN