=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750339594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL S WILLIAMSON M.D., PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 W WOOLBRIGHT RD SUITE 100
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-6398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-3909
-----------------------------------------------------
Fax | 561-732-0166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 W WOOLBRIGHT RD SUITE 100
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-6398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-3909
-----------------------------------------------------
Fax | 561-732-0166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 59584
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME77317
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------