Healthcare Provider Details

I. General information

NPI: 1194764290
Provider Name (Legal Business Name): JASON L WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD
LITTLE ROCK AR
72205-6324
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-1902
  • Fax: 501-202-1512
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberE5433
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: