Healthcare Provider Details

I. General information

NPI: 1477085462
Provider Name (Legal Business Name): JUSTIN WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 COURT ST
PUEBLO CO
81003-2720
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-6755
  • Fax: 719-583-2236
Mailing address:
  • Phone: 970-624-2403
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0074466
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: