Provider Demographics
NPI:1508831769
Name:WILLIAMS, TODD LAVOY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:LAVOY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4211 W BOY SCOUT BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5724
Mailing Address - Country:US
Mailing Address - Phone:855-485-3262
Mailing Address - Fax:813-443-8255
Practice Address - Street 1:5301 AVION PARK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1416
Practice Address - Country:US
Practice Address - Phone:855-485-3262
Practice Address - Fax:813-443-8255
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00372492OtherMEDICARE RAILROAD
FLP32890Medicare UPIN
FLES612XMedicare PIN