Healthcare Provider Details

I. General information

NPI: 1346240306
Provider Name (Legal Business Name): TODD E WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 OLEANDER DR
MYRTLE BEACH SC
29577-5742
US

IV. Provider business mailing address

2234 COLONIAL BLVD MANAGED CARE DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-9415
  • Fax: 843-449-2160
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number14002
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number200400438
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier063W8
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS
# 2
Identifier32936
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDCOST
# 3
Identifier89063W8
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 4
Identifier140009
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 5
Identifier503356
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBCBS
# 6
Identifier9620580
Identifier TypeOTHER
Identifier State
Identifier IssuerGHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: