Healthcare Provider Details

I. General information

NPI: 1689424673
Provider Name (Legal Business Name): KIRK G WILLIAMS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

515 W BUCKEYE RD STE 304
PHOENIX AZ
85003-2693
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-5612
  • Fax:
Mailing address:
  • Phone: 602-243-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number77793
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number77793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: