Provider Demographics
NPI:1205263241
Name:DANZEISEN, WILLIAM CRAIG (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CRAIG
Last Name:DANZEISEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8640 PHILIPS HWY
Mailing Address - Street 2:STE 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1207
Mailing Address - Country:US
Mailing Address - Phone:904-469-2432
Mailing Address - Fax:904-779-3348
Practice Address - Street 1:8640 PHILIPS HWY
Practice Address - Street 2:STE 10
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1207
Practice Address - Country:US
Practice Address - Phone:904-469-2432
Practice Address - Fax:904-779-3348
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-06
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016978300Medicaid
FL87873WMedicare PIN
FL016978300Medicaid