Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 000796 | CT |
NPI | 1821084005 |
---|---|
Provider Name | Dr. Matthew Clay Williams |
First Address | Winsted, CT 06098-1657 |
Second Address | Winsted, CT 06098-1657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U03152 | (02) | CT |