Provider Demographics
NPI:1225443195
Name:DONALD J WILLEMS, DO
Entity Type:Organization
Organization Name:DONALD J WILLEMS, DO
Other - Org Name:DONALD J WILLEMS, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-260-2363
Mailing Address - Street 1:1898 W HILLSBORO BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1434
Mailing Address - Country:US
Mailing Address - Phone:954-571-9392
Mailing Address - Fax:954-571-6788
Practice Address - Street 1:1898 W HILLSBORO BLVD
Practice Address - Street 2:STE H
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1434
Practice Address - Country:US
Practice Address - Phone:954-571-9392
Practice Address - Fax:954-571-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10400261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74658Medicare PIN