Healthcare Provider Details

I. General information

NPI: 1093841454
Provider Name (Legal Business Name): GUY WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MARSHALL ST
LEAVENWORTH KS
66048-3235
US

IV. Provider business mailing address

920 MAIN ST STE 300
KANSAS CITY MO
64105-2008
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-1100
  • Fax:
Mailing address:
  • Phone: 816-561-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number04-23226
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: