MEDICARE: DR. CHARLES D WILLIAMS SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G46343	CA

General Provider Information

NPI Number	:	1043204803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES D WILLIAMS SR. MD

Provider Business Mailing Address
First Line	:	347 ANTIQUA WAY
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-4004
Country	:	US
Telephone Number	:	850-897-9153
Fax Number	:	850-883-8133

Provider Business Practice Location Address
First Line	:	307 BOATNER RD
Second Line	:	STE 114
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1391
Country	:	US
Telephone Number	:	850-883-8221
Fax Number	:	850-883-8133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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