Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD420429 | PA |
NPI | 1407899404 |
---|---|
Provider Name | Dr. Joyce Monica Williams |
First Address | Philadelphia, PA 19131-1475 |
Second Address | Philadelphia, PA 19131-1475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013344140091 | (05) | PA |
H77203 | (02) | PA |
IBC 1723988 | INDEPENDENCE BLUE CROSS (01) | PA |