Provider Demographics
NPI:1124072863
Name:WILLIAMS, REDDOCH EVANS (MD)
Entity type:Individual
Prefix:
First Name:REDDOCH
Middle Name:EVANS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BEACHVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2802
Mailing Address - Country:US
Mailing Address - Phone:850-863-3330
Mailing Address - Fax:
Practice Address - Street 1:251 BEACHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2802
Practice Address - Country:US
Practice Address - Phone:850-863-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72912Medicare UPIN
FL44260AMedicare PIN