Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35040769W | OH |
NPI | 1003835513 |
---|---|
Provider Name | Donald R Williams |
First Address | Cincinnati, OH 45244-4238 |
Second Address | Cincinnati, OH 45244-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0357911 | (05) | OH |
B95450 | (02) | OH |