Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0085619 | MD |
Y | 111NI0900X | Internist | D0085619 | MD |
N | 207R00000X | Internist | DR.0058145 | CO |
N | 111NI0900X | Internist | DR.0058145 | CO |
N | 207RC0200X | Critical Care Medicine | MD2021-0218 | NM |
NPI | 1023436730 |
---|---|
Provider Name | Dr. John Glenn Williams |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 08/06/2021 |