Provider Demographics
NPI:1194972224
Name:WILLEMS, DONALD J (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:WILLEMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1341 S POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4313
Mailing Address - Country:US
Mailing Address - Phone:954-979-9979
Mailing Address - Fax:954-979-9545
Practice Address - Street 1:1341 S POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4313
Practice Address - Country:US
Practice Address - Phone:954-979-9979
Practice Address - Fax:954-979-9545
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS10400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74658Medicare PIN