Provider Demographics
NPI:1134301427
Name:WILLIAMSON FERRARA GALLAGHER & DEJESUS MD PA
Entity Type:Organization
Organization Name:WILLIAMSON FERRARA GALLAGHER & DEJESUS MD PA
Other - Org Name:COLON & RECTAL CLINIC OF ORLANDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-422-3790
Mailing Address - Street 1:110 W UNDERWOOD ST
Mailing Address - Street 2:STE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1139
Mailing Address - Country:US
Mailing Address - Phone:407-422-3790
Mailing Address - Fax:407-425-4358
Practice Address - Street 1:110 W UNDERWOOD ST
Practice Address - Street 2:STE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1139
Practice Address - Country:US
Practice Address - Phone:407-422-3790
Practice Address - Fax:407-425-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374448500Medicaid
FL39059Medicare PIN