Provider Demographics
NPI:1497983241
Name:THETFORD, WILLIAM HAMILTON (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HAMILTON
Last Name:THETFORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9338
Mailing Address - Country:US
Mailing Address - Phone:239-278-4100
Mailing Address - Fax:239-278-3907
Practice Address - Street 1:2540 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9338
Practice Address - Country:US
Practice Address - Phone:239-278-4100
Practice Address - Fax:239-278-3907
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM785213ES0103X
FLPO3911213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020059Medicaid
TN103I480386Medicare PIN
NCNC8172AMedicare PIN