Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 173876 | CA |
Y | 1223X0400X | Orthodontists | OR1980 | MS |
NPI | 1013105451 |
---|---|
Provider Name | Dr. Michael Owen Williams |
First Address | Gulfport, MS 39507-1849 |
Second Address | Gulfport, MS 39507-1849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 11/10/2007 |