Healthcare Provider Details

I. General information

NPI: 1487646618
Provider Name (Legal Business Name): RICHARD ALLAN WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

1045 N VISTA VERDE
LITCHFIELD PARK AZ
85340-4501
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-3130
  • Fax:
Mailing address:
  • Phone: 623-856-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4993
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: