Healthcare Provider Details

I. General information

NPI: 1023009040
Provider Name (Legal Business Name): VICTOR BERNARD WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9712 W MARKHAM ST
LITTLE ROCK AR
72205-2124
US

IV. Provider business mailing address

PO BOX 5589
JACKSONVILLE AR
72078-5589
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-0499
  • Fax: 501-217-0222
Mailing address:
  • Phone: 501-280-0499
  • Fax: 501-217-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberE-2372
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: