Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME1498600 | FL |
NPI | 1073977310 |
---|---|
Provider Name | Alexander Williams |
First Address | Port Charlotte, FL 33981-3394 |
Second Address | Vero Beach, FL 32960-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073977310 | (05) | VA |