MEDICARE: DR. RICHARD MALCOLM WILLIAMS MD

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	2085R0202X	Diagnostic Radiology Physician	TM00496	TX
2	2085R0202X	Diagnostic Radiology Physician	01069024A	IN
3	2085R0202X	Diagnostic Radiology Physician	2406	MI
4	2085R0202X	Diagnostic Radiology Physician	MD60668713	WA
5	2085R0202X	Diagnostic Radiology Physician	0101242773	VA
6	2085R0202X	Diagnostic Radiology Physician	036051496	IL
7	2085R0202X	Diagnostic Radiology Physician	MD441846	PA
8	2085R0202X	Diagnostic Radiology Physician	26165	AZ
9	2085R0202X	Diagnostic Radiology Physician	D0082180	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	501842	OTHER	AZ	AHCCCS
2	1Z7105	OTHER	AZ	HEALTHNET
3	AZ0831550	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1962450635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD MALCOLM WILLIAMS MD

Provider Business Mailing Address
First Line	:	10455 EMMA LN NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-8608
Country	:	US
Telephone Number	:	360-656-6396
Fax Number	:	231-346-6255

Provider Business Practice Location Address
First Line	:	10455 EMMA LN NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-8608
Country	:	US
Telephone Number	:	360-656-6396
Fax Number	:	231-346-6255

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/02/2019

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