Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 012419 | MI |
NPI | 1003812397 |
---|---|
Provider Name | Dr. James D Williams |
First Address | Clarkston, MI 48346-2992 |
Second Address | Clarkston, MI 48346-2992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 16/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12160687 | (05) | MI |
JW012419 | BLUE CROSS MEDICAL PRO # (01) | MI |
T82975 | (02) | MI |