Provider Demographics
NPI:1144218991
Name:WILLIAMSON, MALCOLM EDWARD II (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:EDWARD
Last Name:WILLIAMSON
Suffix:II
Gender:M
Credentials:MD
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 6200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-6200
Mailing Address - Country:US
Mailing Address - Phone:352-671-4300
Mailing Address - Fax:352-671-4393
Practice Address - Street 1:1818 SW 15TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3548
Practice Address - Country:US
Practice Address - Phone:352-671-4300
Practice Address - Fax:352-671-4393
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME728682085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258744100Medicaid
FL258744100Medicaid
H14145Medicare UPIN