Provider Demographics
NPI:1548721343
Name:SHIPMAN, WILLIAM F III (P A)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:SHIPMAN
Suffix:III
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18379
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-8379
Mailing Address - Country:US
Mailing Address - Phone:850-588-3880
Mailing Address - Fax:850-914-7045
Practice Address - Street 1:11111 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2448
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:850-914-7045
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609801257OtherGROUP NPI