Healthcare Provider Details

I. General information

NPI: 1538118245
Provider Name (Legal Business Name): ROGER TODD WILLIAMS MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N DIXIE HWY
CAVE CITY KY
42127-9512
US

IV. Provider business mailing address

400 N DIXIE HWY
CAVE CITY KY
42127-9512
US

V. Phone/Fax

Practice location:
  • Phone: 270-773-3737
  • Fax: 270-773-3738
Mailing address:
  • Phone: 270-773-3737
  • Fax: 270-773-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number37488
License Number StateKY

VIII. Authorized Official

Name: DR. ROGER TODD WILLIAMS
Title or Position: OWNER/ PHYSICIAN
Credential: M.D.
Phone: 270-773-3737