Provider Demographics
NPI:1144496969
Name:WILLIAMS, DAVE
Entity type:Individual
Prefix:MR
First Name:DAVE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-303-1501
Mailing Address - Fax:239-303-9297
Practice Address - Street 1:2718 LEE BLVD
Practice Address - Street 2:STE C
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-1537
Practice Address - Country:US
Practice Address - Phone:239-303-1501
Practice Address - Fax:239-303-9297
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist