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Individual

WILLIAM P MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3109 W. AZEELE STREET, TAMPA, FL 33609
(813) 875-5437
(813) 873-9373
Mailing address
3109 W. AZEELE STREET, TAMPA, FL 33609
(813) 875-5437
(813) 873-9373

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME65603
FL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
ME65603
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0805198
UNITED HEALTHCARE
FL
01
2074423
AETNA
FL
05
250029900
FL
01
31233
BCBS FLORIDA
FL
01
5204189
AETNA
FL
01
6012101
GHI
NY
Enumeration date
07/01/2005
Last updated
12/05/2017
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