Provider Demographics
NPI:1760484034
Name:WILLIAMS, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:725 S TROPICAL TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4952
Mailing Address - Country:US
Mailing Address - Phone:321-751-7222
Mailing Address - Fax:321-454-7494
Practice Address - Street 1:490 CENTRE LAKE DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1113
Practice Address - Country:US
Practice Address - Phone:800-476-8646
Practice Address - Fax:919-382-3210
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6588207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57352OtherBCBS GROUP # 34457
FL379858500Medicaid
FL57352OtherBCBS GROUP # 45368
FL57352FMedicare ID - Type UnspecifiedGROUP # 45368
FL379858500Medicaid
FL57352OtherBCBS GROUP # 34457
FL57352GMedicare ID - Type UnspecifiedGROUP # 34457