Provider Demographics
NPI:1760428288
Name:PRIMAS, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:PRIMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3477 WELWYN WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-8204
Mailing Address - Country:US
Mailing Address - Phone:850-894-2814
Mailing Address - Fax:850-894-3132
Practice Address - Street 1:194 NE HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2546
Practice Address - Country:US
Practice Address - Phone:850-973-8851
Practice Address - Fax:850-973-8365
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 59715207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF30676Medicare UPIN
FL15231 YMedicare ID - Type Unspecified