Healthcare Provider Details

I. General information

NPI: 1568514701
Provider Name (Legal Business Name): ROBERT ALLEN WILLIAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W BAY ST
WAUCHULA FL
33873-3135
US

IV. Provider business mailing address

461 E TEN MILE RD
PENSACOLA FL
32534-9712
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-4700
  • Fax: 863-773-2916
Mailing address:
  • Phone: 863-773-4700
  • Fax: 863-773-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: