Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 75443 | MA |
NPI | 1013903459 |
---|---|
Provider Name | Dr. David Adam Williams |
First Address | O Fallon, IL 62269-7043 |
Second Address | Scott Afb, IL 62225-5250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH000 | (02) | IL |