Provider Demographics
NPI:1336143676
Name:WILLIAMSON, PAUL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:WILLIAMSON
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 1:110 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43182208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057703100Medicaid
FL07265TMedicare PIN
FL057703100Medicaid
FL07265YMedicare ID - Type Unspecified
FL07265UMedicare PIN
FLD51889Medicare UPIN