Provider Demographics
NPI:1083701452
Name:TINGLE, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:TINGLE
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 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-662-7980
Mailing Address - Fax:
Practice Address - Street 1:3303 OVERSEAS HWY STE 100
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:786-662-5610
Practice Address - Fax:786-533-9980
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59349208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376030800Medicaid
FL1484132OtherCIGNA
FL1193488OtherWELLCARE
FL208525OtherAVMED
FLP01807653OtherCLEAR HEALTH
FLP104324OtherFREEDOM HEALTH
340009780OtherMEDICARE RAILROAD
FLP01078296OtherRAILROAD MEDICARE
FLQMP000005228656OtherMOLINA
FL165719OtherUNIVERSAL
FLP512083OtherOPTIMUM
FL4605729OtherAETNA
FLP01078296OtherRAILROAD MEDICARE
FL1484132OtherCIGNA
FLQMP000005228656OtherMOLINA
F77285Medicare UPIN