Provider Demographics
NPI:1598744393
Name:WILLIAMS, JOHN P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
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 1:2821 SEABREEZE DR S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3931
Mailing Address - Country:US
Mailing Address - Phone:727-667-2074
Mailing Address - Fax:727-343-4716
Practice Address - Street 1:2821 SEABREEZE DR S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-3931
Practice Address - Country:US
Practice Address - Phone:727-667-2074
Practice Address - Fax:727-343-4716
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4755207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274114800Medicaid
FLU6020XMedicare PIN
FLU6020SMedicare PIN
FLU6020UMedicare PIN
FLU6020YMedicare PIN
FLC64597Medicare UPIN
FLU6020TMedicare PIN