Healthcare Provider Details

I. General information

NPI: 1801727961
Provider Name (Legal Business Name): MARK WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 W 20TH STREET RD UNIT 1
GREELEY CO
80634-3670
US

IV. Provider business mailing address

3620 W 10TH STREET STE B PMB #121
GREELEY CO
80634-1821
US

V. Phone/Fax

Practice location:
  • Phone: 970-980-4706
  • Fax:
Mailing address:
  • Phone: 303-995-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: