Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | TRN9181 | FL |
NPI | 1003014838 |
---|---|
Provider Name | Michael Williams |
First Address | Daytona Beach, FL 32117-4018 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |