Basic Information
| Provider Information | |||||||||
| NPI: | 1346240306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | MANAGED CARE DEPT. | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434499415 | ||||||||
| FaxNumber: | 8434492160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 14002 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 200400438 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 063W8 | 01 | NC | BCBS | OTHER | 32936 | 01 | MEDCOST | OTHER | 89063W8 | 05 | NC | MEDICAID | 140009 | 05 | SC | MEDICAID | 503356 | 01 | PA | BCBS | OTHER | 9620580 | 01 | GHI | OTHER |