Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 0535122 | KS |
N | 207RH0003X | Hematology & Oncology | O-0785 | ID |
Y | 207RX0202X | Medical Oncology | O-0785 | ID |
NPI | 1043461817 |
---|---|
Provider Name | Travis G Williams |
First Address | Boise, ID 83712-6241 |
Second Address | Meridian, ID 83642-6351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 08/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043461817 | (05) | ID |