Provider Demographics
NPI:1952389330
Name:ROGER N WILLIAMS MD PA
Entity Type:Organization
Organization Name:ROGER N WILLIAMS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-5226
Mailing Address - Street 1:773 4TH AVE N
Mailing Address - Street 2:STE E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5778
Mailing Address - Country:US
Mailing Address - Phone:239-262-5226
Mailing Address - Fax:239-262-4501
Practice Address - Street 1:773 4TH AVE N
Practice Address - Street 2:STE E
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5778
Practice Address - Country:US
Practice Address - Phone:239-262-5226
Practice Address - Fax:239-262-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11088Medicare ID - Type Unspecified
FLD52097Medicare UPIN