Healthcare Provider Details

I. General information

NPI: 1548294069
Provider Name (Legal Business Name): JOHN M WILLIAMS SR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SOUTH 8TH STREET PO BOX 38958
COLORADO SPRINGS CO
80937-8958
US

IV. Provider business mailing address

1540 SOUTH 8TH STREET PO BOX 38958
COLORADO SPRINGS CO
80937-8958
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-9749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26446
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number26446
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number26446
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number26446
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number26446
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: