Healthcare Provider Details

I. General information

NPI: 1447983499
Provider Name (Legal Business Name): LIONEL DUKANE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35864 W MARIN AVE
MARICOPA AZ
85138-2198
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 520-560-3468
  • Fax: 520-407-5398
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-407-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number11553228
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: