Healthcare Provider Details

I. General information

NPI: 1588078489
Provider Name (Legal Business Name): JEFFREY W WILLIAMS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11528 US HIGHWAY 19
PORT RICHEY FL
34668-1442
US

IV. Provider business mailing address

11528 US HIGHWAY 19
PORT RICHEY FL
34668-1442
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-2151
  • Fax: 727-868-8251
Mailing address:
  • Phone: 727-868-2151
  • Fax: 727-868-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: