Healthcare Provider Details

I. General information

NPI: 1598744393
Provider Name (Legal Business Name): JOHN P WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 SEABREEZE DR S
GULFPORT FL
33707-3931
US

IV. Provider business mailing address

2821 SEABREEZE DR S
GULFPORT FL
33707-3931
US

V. Phone/Fax

Practice location:
  • Phone: 727-667-2074
  • Fax: 727-343-4716
Mailing address:
  • Phone: 727-667-2074
  • Fax: 727-343-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOS4755
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberOS4755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: