Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101026065 | VA |
NPI | 1164459715 |
---|---|
Provider Name | Mason Miller Williams |
First Address | Richmond, VA 23226-1935 |
Second Address | Richmond, VA 23226-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6961231 | (05) | VA |
B07116 | (02) | VA |