Provider Demographics
NPI:1801834015
Name:WILEY, WILLIAM JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:WILEY
Suffix:
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 1:10506 LUCAYA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3326
Mailing Address - Country:US
Mailing Address - Phone:813-973-8560
Mailing Address - Fax:813-973-8560
Practice Address - Street 1:10506 LUCAYA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3326
Practice Address - Country:US
Practice Address - Phone:813-973-8560
Practice Address - Fax:813-973-8560
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3008213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061658210OtherTRICARE PROVIDER NUMBER
FL65920OtherBC/BS OF FL PROVIDER NUMB
FLN307018OtherWELLCARE OF FL PROVIDER N
FL340282700Medicaid
FL340282700Medicaid
FLN307018OtherWELLCARE OF FL PROVIDER N