Provider Demographics
NPI:1376509679
Name:WILLIAMS, WENDELL HIEBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:HIEBERT
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1361 13TH AVE S STE 245
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3238
Mailing Address - Country:US
Mailing Address - Phone:904-396-0300
Mailing Address - Fax:904-396-0309
Practice Address - Street 1:1361 13TH AVE S STE 245
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-493-7174
Practice Address - Fax:904-694-0696
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29168207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1608901OtherCIGNA
FL78589OtherFLORIDA BLUE - INDIVIDUAL
FL40538OtherAVMED
FLDT8174OtherRR MEDICARE - GROUP
FLPO1494164OtherRR MEDICARE
FL004E6OtherFLORIDA BLUE - GROUP
FL0098365-00OtherFL MEDICAID - GROUP
FL0082748-00Medicaid
FLPO1494164OtherRR MEDICARE
D58562Medicare UPIN