Healthcare Provider Details

I. General information

NPI: 1609225762
Provider Name (Legal Business Name): JASON DOUGLAS WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 S RACKHAM WAY STE 100
MERIDIAN ID
83642-8938
US

IV. Provider business mailing address

1256 S RACKHAM WAY STE 100
MERIDIAN ID
83642-8938
US

V. Phone/Fax

Practice location:
  • Phone: 208-800-9040
  • Fax: 208-252-6479
Mailing address:
  • Phone: 208-800-9040
  • Fax: 208-252-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM-16138
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD221988
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: