Provider Demographics
NPI:1427138148
Name:WILLIAMS, HAROLD S (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:S
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 1:100 NW 170 STREET
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:305-652-6466
Mailing Address - Fax:605-652-3104
Practice Address - Street 1:100 NW 170 STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:305-652-6466
Practice Address - Fax:305-652-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0859025OtherAETNA HMO
FL4068035OtherAETNA
FL000562OtherNHP
FL059789900Medicaid
FL95180OtherBLUE CROSS BLUE SHIELD
FL000712OtherAVMED
FL9270245OtherCIGNA
FL95180Medicare PIN
FL059789900Medicaid