Provider Demographics
NPI:1821073362
Name:BOTT, WILLIAM K (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:BOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:NAVAL HOSPITAL JACKSONVILLE--ORTHO DEPT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-542-7366
Mailing Address - Fax:904-542-7051
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:NAVAL HOSPITAL JACKSONVILLE--ORTHO DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7366
Practice Address - Fax:904-542-7051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00033760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
47370YMedicare ID - Type Unspecified
D55030Medicare UPIN