Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 01064129A | IN |
N | 207RC0200X | Critical Care Medicine | 016380 | ME |
N | 207RC0200X | Critical Care Medicine | 60181-20 | WI |
N | 207RC0200X | Critical Care Medicine | MD434996 | PA |
N | 207RP1001X | Pulmonary Disease | 01064129A | IN |
N | 207RP1001X | Pulmonary Disease | 016380 | ME |
Y | 207RP1001X | Pulmonary Disease | 60181 | WI |
N | 207RP1001X | Pulmonary Disease | MD434996 | PA |
NPI | 1003971490 |
---|---|
Provider Name | Dr. Carl Marc Williams |
First Address | Weston, WI 54476-5220 |
Second Address | Weston, WI 54476-5220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000528048 | ANTHEM PROVIDER NUMBER (01) | IN |
1003971490 | (05) | WI |
1021751160001 | (05) | PA |
200869120 | (05) | IN |
2051760 | HIGHMARK BLUE SHIELD (01) | PA |
823273 | FIRST PRIORITY HEALTH (01) | PA |
G86977 | (02) | ME |
PENDING | PHCS PID NUMBER (01) | IN |