Provider Demographics
NPI:1073587861
Name:WILLIAMS, JORY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JORY
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:501 N HOWARD AVE
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1244
Mailing Address - Country:US
Mailing Address - Phone:813-253-2727
Mailing Address - Fax:813-253-2729
Practice Address - Street 1:501 N HOWARD AVE
Practice Address - Street 2:SUITE # 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1244
Practice Address - Country:US
Practice Address - Phone:813-253-2727
Practice Address - Fax:813-253-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0057402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12117BOtherBCBS OF FLORIDA
FL1706656OtherCIGNA
FL2520705OtherAETNA
FL1706656OtherCIGNA
FL12117CMedicare ID - Type Unspecified