Provider Demographics
NPI:1851592075
Name:CANTWELL, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:CANTWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18167 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 650
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3528
Mailing Address - Country:US
Mailing Address - Phone:727-533-8707
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:211 4TH ST
Practice Address - Street 2:EMCARE
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:727-533-8707
Practice Address - Fax:727-507-3618
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.201136207R00000X, 207RC0200X
TXN3533207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208430301Medicaid
TX208430302Medicaid
TXTIN PLUS 042OtherTRICARE
TX8V3851OtherBCBS
AR181274001Medicaid
LA1092819Medicaid
LA09281Medicaid
TX208430301Medicaid
TX8L22503Medicare Oscar/Certification
TX208430302Medicaid