Provider Demographics
NPI:1568514701
Name:WILLIAMS, ROBERT ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 E TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-9712
Mailing Address - Country:US
Mailing Address - Phone:863-773-4700
Mailing Address - Fax:863-773-2916
Practice Address - Street 1:117 W BAY ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3135
Practice Address - Country:US
Practice Address - Phone:863-773-4700
Practice Address - Fax:863-773-2916
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1373Medicaid
SCP73649OtherCAROLINA CARE PLAN
56-2092480OtherFEDERAL TAX ID
SC010721Medicaid
153867800OtherDEPT OF LABOR
SC010721Medicaid
SC6003Medicare PIN