Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 1999135803 | MO |
NPI | 1790728632 |
---|---|
Provider Name | Dr. Cyd Charisse Thomas Williams |
First Address | Saint Charles, MO 63303-8301 |
Second Address | Saint Charles, MO 63303-2104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201597188 | TAX IDENTIFICATION (01) | MO |
204812812 | (05) | MO |
G22639 | (02) | MO |