Healthcare Provider Details

I. General information

NPI: 1770788796
Provider Name (Legal Business Name): RICHARD BART WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 W 13TH ST
GREELEY CO
80634-4821
US

IV. Provider business mailing address

2300 SNOW MESA CT
FORT COLLINS CO
80528-8588
US

V. Phone/Fax

Practice location:
  • Phone: 970-348-0020
  • Fax:
Mailing address:
  • Phone: 585-857-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number52620
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: