Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | E-2372 | AR |
NPI | 1023009040 |
---|---|
Provider Name | Dr. Victor Bernard Williams |
First Address | Jacksonville, AR 72078-5589 |
Second Address | Little Rock, AR 72205-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150104001 | (05) | AR |
H91479 | (02) | AR |