Individual
JERRY WILLIAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1454 MADISON AVE W, IMMOKALEE, FL 34142-2200
(239) 658-3196
(239) 658-3175
Mailing address
24 FALCONWOOD CT, FORT MYERS, FL 33919-7535
(239) 658-3196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME29350
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257304100
—
FL
Enumeration date
04/04/2007
Last updated
06/06/2011
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