Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036102742 | IL |
NPI | 1104812155 |
---|---|
Provider Name | Dr. James R Williams |
First Address | Peoria, IL 61614-3294 |
Second Address | Peoria, IL 61614-3294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 31/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102742 | (05) | IL |