Provider Demographics
NPI:1932183951
Name:WILLIAMS, MARK CARL (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CARL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9981 HEALTH PARK CIRCLE
Mailing Address - Street 2:SUITE 159
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-481-5477
Mailing Address - Fax:239-481-5892
Practice Address - Street 1:9981 HEALTHPARK CIRCLE
Practice Address - Street 2:SUITE 159
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-481-5477
Practice Address - Fax:239-481-5892
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME50517207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046651400Medicaid
FL046651400Medicaid
FL04585XMedicare ID - Type Unspecified