Provider Demographics
NPI:1346240306
Name:WILLIAMS, TODD E (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4708 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5742
Practice Address - Country:US
Practice Address - Phone:843-449-9415
Practice Address - Fax:843-449-2160
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC140022085R0001X
SC2004004382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC063W8OtherBCBS
32936OtherMEDCOST
NC89063W8Medicaid
SC140009Medicaid
PA503356OtherBCBS
9620580OtherGHI
SC140009Medicaid
NC063W8OtherBCBS
920006060Medicare ID - Type UnspecifiedRAILROAD MEDICARE