Provider Demographics
NPI:1245745744
Name:R. BRIAN WILLIAMS, DO, PA
Entity Type:Organization
Organization Name:R. BRIAN WILLIAMS, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-919-0219
Mailing Address - Street 1:3006 SHIPWATCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-9601
Mailing Address - Country:US
Mailing Address - Phone:727-919-0219
Mailing Address - Fax:
Practice Address - Street 1:2985 POST ROCK CT
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7315
Practice Address - Country:US
Practice Address - Phone:727-919-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161936700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty