Provider Demographics
NPI:1861487308
Name:WILLIAMS, EDWARDO D (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARDO
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 HILLBROOKE TRL STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7914
Mailing Address - Country:US
Mailing Address - Phone:850-878-2637
Mailing Address - Fax:850-878-2053
Practice Address - Street 1:1910 HILLBROOKE TRL STE 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7914
Practice Address - Country:US
Practice Address - Phone:850-878-2637
Practice Address - Fax:850-878-2053
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046176800Medicaid
FL046176800Medicaid
FL03985AMedicare PIN
FLCS313ZMedicare PIN