Provider Demographics
NPI:1932152394
Name:WILLIAMS, BROOKE H (MD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:H
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 1:4944 W SAN RAFAEL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5404
Mailing Address - Country:US
Mailing Address - Phone:813-288-8932
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87940207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00275917OtherMEDICARE RAILROAD
FL29264OtherFL BCBS PROVIDER NUMBER
FL273657800Medicaid
FL7245817OtherAETNA GTBA
FL29264YMedicare ID - Type UnspecifiedGTB PROVIDER NUMBER
FLP00275917OtherMEDICARE RAILROAD
FLI41364Medicare UPIN