Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
N | 175F00000X | Naturopath | 732032 | MS |
N | 207R00000X | Internist | 732032 | MS |
N | 111NI0900X | Internist | 732032 | MS |
Y | 208D00000X | General Practice Physician | 732032 | MS |
NPI | 1003326406 |
---|---|
Provider Name | Dr. Shamar Tyre Williams |
First Address | Bronx, NY 10465-1717 |
Second Address | Bronx, NY 10465-1717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 19/11/2019 |