Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35044614 | OH |
N | 208600000X | Surgeon | 35044614 | OH |
Y | 2086S0129X | Vascular Surgeon | 35044614 | OH |
NPI | 1023082401 |
---|---|
Provider Name | Philip Copelain Williams JR. |
First Address | Dayton, OH 45408 |
Second Address | Dayton, OH 45408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 04/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0465741 | (05) | OH |
D31251 | (02) | OH |