Provider Demographics
NPI:1215909262
Name:WILLIAMS, TIMOTHY B (DO)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W ALEXANDER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7116
Mailing Address - Country:US
Mailing Address - Phone:813-659-9800
Mailing Address - Fax:813-659-9807
Practice Address - Street 1:511 W ALEXANDER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7116
Practice Address - Country:US
Practice Address - Phone:813-659-9800
Practice Address - Fax:813-659-9807
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7802208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256690700Medicaid