Provider Demographics
NPI:1730293796
Name:PACKARD, WILLIAM I (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:I
Last Name:PACKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1221 W LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1857
Mailing Address - Country:US
Mailing Address - Phone:850-469-3500
Mailing Address - Fax:850-595-1400
Practice Address - Street 1:1221 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1857
Practice Address - Country:US
Practice Address - Phone:850-469-3500
Practice Address - Fax:850-595-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1379582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104585800Medicaid