Provider Demographics
NPI:1689666331
Name:DUTCH, WILLIAM M JR (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:DUTCH
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 KIRKVILLE RD
Mailing Address - Street 2:SUITE C-202
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-701-2929
Mailing Address - Fax:315-701-1473
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:STE 202
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-701-2929
Practice Address - Fax:315-701-1473
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005690213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02181744Medicaid
NYU84636Medicare UPIN
NY02181744Medicaid