Provider Demographics
NPI:1396742961
Name:ADDINGTON, WILLIAM ROBERT II (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:ADDINGTON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3160
Mailing Address - Country:US
Mailing Address - Phone:321-951-8137
Mailing Address - Fax:321-951-8138
Practice Address - Street 1:301 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3160
Practice Address - Country:US
Practice Address - Phone:321-951-8137
Practice Address - Fax:321-951-8138
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-06-11
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLOS0006793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376556300Medicaid
K5336Medicare PIN
FLF83895Medicare UPIN