Provider Demographics
NPI:1184630238
Name:WILLIAMS, KEITH NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:NORMAN
Last Name:WILLIAMS
Suffix:
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 1:18712 BELLEVISTA CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5757
Mailing Address - Country:US
Mailing Address - Phone:617-245-0897
Mailing Address - Fax:
Practice Address - Street 1:18712 BELLEVISTA CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-5757
Practice Address - Country:US
Practice Address - Phone:617-245-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189619Medicaid
MAJ24414OtherBLUE CROSS
MAHV0126OtherHARVARD PILGRIM
MA156802OtherTUFTS
MAA28861Medicare ID - Type Unspecified
MA3189619Medicaid