Provider Demographics
NPI:1881655272
Name:DEMARSE, WILLIAM ROBEY III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBEY
Last Name:DEMARSE
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:12479 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0913
Mailing Address - Country:US
Mailing Address - Phone:813-972-4199
Mailing Address - Fax:813-972-5753
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-971-6000
Practice Address - Fax:813-972-5753
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2019-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14829Medicare UPIN
FLE4634YMedicare PIN
E4364AMedicare ID - Type Unspecified
FLE4634ZMedicare PIN