Provider Demographics
NPI:1154428357
Name:PETER B WILLIAMS DPM CWS PA
Entity type:Organization
Organization Name:PETER B WILLIAMS DPM CWS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-869-9191
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673-1084
Mailing Address - Country:US
Mailing Address - Phone:727-869-9191
Mailing Address - Fax:727-734-1808
Practice Address - Street 1:10148 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3743
Practice Address - Country:US
Practice Address - Phone:727-869-9191
Practice Address - Fax:727-734-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPO0002239213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27-05819OtherEVERCARE (UHC)
FL058885700Medicaid
FLP00116444OtherRAILROAD MEDICARE
FL27-05819OtherEVERCARE (UHC)
FL058885700Medicaid