Provider Demographics
NPI:1043522915
Name:WILLIAMS, RORY (MD)
Entity type:Individual
Prefix:DR
First Name:RORY
Middle Name:
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 1:1064 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3301
Mailing Address - Country:US
Mailing Address - Phone:863-519-9797
Mailing Address - Fax:863-533-8723
Practice Address - Street 1:1064 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3300
Practice Address - Country:US
Practice Address - Phone:863-519-9797
Practice Address - Fax:863-533-8723
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.058880207Q00000X
FLME120589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201198680Medicaid
IN000000854287OtherBCBS
IN000000854287OtherBCBS