Healthcare Provider Details

I. General information

NPI: 1215909262
Provider Name (Legal Business Name): TIMOTHY B WILLIAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W ALEXANDER ST SUITE 2
PLANT CITY FL
33563-7116
US

IV. Provider business mailing address

511 W ALEXANDER ST SUITE 2
PLANT CITY FL
33563-7116
US

V. Phone/Fax

Practice location:
  • Phone: 813-659-9800
  • Fax: 813-659-9807
Mailing address:
  • Phone: 813-659-9800
  • Fax: 813-659-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS7802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: