Healthcare Provider Details

I. General information

NPI: 1487805081
Provider Name (Legal Business Name): JEREMY L WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST SUITE 200
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

1419 BRIERCLIFF DR
ORLANDO FL
32806-1407
US

V. Phone/Fax

Practice location:
  • Phone: 407-237-6329
  • Fax: 407-649-3083
Mailing address:
  • Phone: 352-258-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN12368
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME108976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: