Provider Demographics
NPI:1073575866
Name:WILLIAMS, JOSHUA R (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
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 21686
Mailing Address - Street 2:CARE OF UNITED SURGICAL ASSISTANTS, INC.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1686
Mailing Address - Country:US
Mailing Address - Phone:877-872-5788
Mailing Address - Fax:866-698-7272
Practice Address - Street 1:12880 COMMODITY PL
Practice Address - Street 2:CARE OF UNITED SURGICAL ASSISTANTS, INC.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3101
Practice Address - Country:US
Practice Address - Phone:877-872-5788
Practice Address - Fax:866-698-7272
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103967363AS0400X
CO1498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2928027 00Medicaid
CO08550531Medicaid
P53797Medicare UPIN
FLU8582YMedicare PIN
458108Medicare ID - Type Unspecified
CO08550531Medicaid
FL2928027 00Medicaid