Healthcare Provider Details

I. General information

NPI: 1740230366
Provider Name (Legal Business Name): ROGER TODD WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N DIXIE HWY
CAVE CITY KY
42127-9546
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1759
US

V. Phone/Fax

Practice location:
  • Phone: 270-773-2600
  • Fax: 270-361-5101
Mailing address:
  • Phone: 270-773-2600
  • Fax: 270-361-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37488
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37488
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: