Provider Demographics
NPI:1689865891
Name:WILLIAMS, KEITH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANTHONY
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:PO BOX 510816
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0816
Mailing Address - Country:US
Mailing Address - Phone:941-764-7117
Mailing Address - Fax:941-764-1049
Practice Address - Street 1:4265 LAURA STREET
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:941-764-7117
Practice Address - Fax:941-764-1049
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00660002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262297100Medicaid
FL26541ZMedicare PIN
FL262297100Medicaid