Provider Demographics
NPI:1104878198
Name:JORY D WILLIAMS M D P A
Entity type:Organization
Organization Name:JORY D WILLIAMS M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-253-2727
Mailing Address - Street 1:501 N HOWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1213
Mailing Address - Country:US
Mailing Address - Phone:813-253-2727
Mailing Address - Fax:813-253-2729
Practice Address - Street 1:501 N HOWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1213
Practice Address - Country:US
Practice Address - Phone:813-253-2727
Practice Address - Fax:813-253-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF6992OtherRAILROAD MCR
FL2520705OtherDR WILLIAMS AETNA
FL1706656OtherDR WILLIAMS CIGNA
FL99442OtherBCBS OF FL
FL12117CMedicare ID - Type UnspecifiedDR WILLIAMS MCR NUMBER