Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038003346 | IL |
N | 111NI0013X | Independent Medical Examiner | 038003346 | IL |
NPI | 1235379769 |
---|---|
Provider Name | Dr. Ronald O Williams |
First Address | Morrison, IL 61270-9536 |
Second Address | Morrison, IL 61270-9536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2009 |
Last Update Date | 24/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038003346 | (05) | IL |
098-15385-40 | BLUE CROSS (01) | IL |
259830 | (02) | IL |