Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2013007946 | MO |
Y | 222Z00000X | Podiatrist | 2013007946 | MO |
N | 213EP1101X | Primary Podiatric Medicine | 1623 | TX |
NPI | 1093873721 |
---|---|
Provider Name | Kimberly Williams |
First Address | Saint Louis, MO 63112-2617 |
Second Address | Saint Louis, MO 63112-2617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 04/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1539371-01 | (05) | TX |
U92246 | (02) | TX |