Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | MD-17867 | HI |
Y | 207RA0401X | Internist - Addiction Medicine | MD14502 | OR |
NPI | 1619967577 |
---|---|
Provider Name | Vern R Williams |
First Address | Portland, OR 97205-1715 |
Second Address | Portland, OR 97227-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134254 | (05) | OR |
2107839 | (05) | WA |
C91054 | (02) | OR |