MEDICARE: WILLIAM EARLE WILLIAMS PA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00403	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306827100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EARLE WILLIAMS PA C

Provider Business Mailing Address
First Line	:	1233 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4049
Country	:	US
Telephone Number	:	503-378-7526
Fax Number	:	503-585-4278

Provider Business Practice Location Address
First Line	:	1233 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4049
Country	:	US
Telephone Number	:	503-378-7526
Fax Number	:	503-585-4278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	04/07/2009

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Directions to “ WILLIAM EARLE WILLIAMS PA C” Practice Location

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