Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 036.120252 | IL |
Y | 207P00000X | Emergency Physician | 02001015A | IN |
N | 207PE0004X | Emergency Medical Services | 02001015AB | IN |
NPI | 1194723247 |
---|---|
Provider Name | Timothy R Williams |
First Address | Lawrenceville, IL 62439 |
Second Address | Lawrenceville, IL 62439-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245815311 | (05) | MO |
E41093 | (02) |