Provider Demographics
NPI:1821327412
Name:DREYER, WILLIAM BRAESKE JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRAESKE
Last Name:DREYER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SW RACQUET CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2303
Mailing Address - Country:US
Mailing Address - Phone:772-286-6880
Mailing Address - Fax:772-382-6284
Practice Address - Street 1:1715 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7520
Practice Address - Country:US
Practice Address - Phone:772-337-2020
Practice Address - Fax:772-337-1704
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 35786207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180010527OtherRAILROAD MEDICARE
FL039720200Medicaid
180010527OtherRAILROAD MEDICARE
FL039720200Medicaid