Provider Demographics
NPI:1376845123
Name:WILLIAMSON, FERRARA, GALLAGHER, DEJESUS MD. PA
Entity Type:Organization
Organization Name:WILLIAMSON, FERRARA, GALLAGHER, DEJESUS MD. PA
Other - Org Name:COLON AND RECTAL PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-648-9151
Mailing Address - Street 1:110 W UNDERWOOD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1139
Mailing Address - Country:US
Mailing Address - Phone:407-648-9151
Mailing Address - Fax:407-426-7269
Practice Address - Street 1:308 GROVELAND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4019
Practice Address - Country:US
Practice Address - Phone:407-648-9151
Practice Address - Fax:407-426-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800025894291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory