MEDICARE: DR. DAVID WILLIAMS DO

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	207P00000X	Emergency Medicine Physician	OS6588	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57352	OTHER	FL	BCBS GROUP # 34457
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	57352	OTHER	FL	BCBS GROUP # 45368
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760484034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILLIAMS DO

Provider Business Mailing Address
First Line	:	725 S TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4952
Country	:	US
Telephone Number	:	321-751-7222
Fax Number	:	321-454-7494

Provider Business Practice Location Address
First Line	:	490 CENTRE LAKE DR NE
Second Line	:	SUITE 200
City	:	PALM BAY
State	:	FL
Zip	:	32907-1113
Country	:	US
Telephone Number	:	800-476-8646
Fax Number	:	919-382-3210

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/14/2021

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Directions to “ DR. DAVID WILLIAMS DO” Practice Location

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