Provider Demographics
NPI:1801934203
Name:HANSBERRY, WILLIAM EDWARD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:HANSBERRY
Suffix:
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0517
Mailing Address - Country:US
Mailing Address - Phone:904-548-1800
Mailing Address - Fax:904-277-7286
Practice Address - Street 1:1620 NECTARINE ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4724
Practice Address - Country:US
Practice Address - Phone:904-548-1860
Practice Address - Fax:904-277-7283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL584208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics