Provider Demographics
NPI:1376528679
Name:WILLIAMS, PETER B (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673-1084
Mailing Address - Country:US
Mailing Address - Phone:727-869-9191
Mailing Address - Fax:727-869-9220
Practice Address - Street 1:10148 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3743
Practice Address - Country:US
Practice Address - Phone:727-869-9191
Practice Address - Fax:727-869-9220
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02239213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058885700Medicaid
FLP00116444OtherRAILROAD MEDICARE
U27676Medicare UPIN
FL65222AMedicare PIN