Healthcare Provider Details

I. General information

NPI: 1760464127
Provider Name (Legal Business Name): DEAN L WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 GIFFORD AVE
AMERICAN FALLS ID
83211-1314
US

IV. Provider business mailing address

590 GIFFORD AVE
AMERICAN FALLS ID
83211-1314
US

V. Phone/Fax

Practice location:
  • Phone: 208-226-5147
  • Fax: 208-226-7002
Mailing address:
  • Phone: 208-226-5147
  • Fax: 208-226-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3687
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: