Healthcare Provider Details

I. General information

NPI: 1407925407
Provider Name (Legal Business Name): WILLIAM LIBERT WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69303 4TH AVE
COVINGTON LA
70433-6612
US

IV. Provider business mailing address

69303 4TH AVE
COVINGTON LA
70433-6612
US

V. Phone/Fax

Practice location:
  • Phone: 985-674-1944
  • Fax: 985-674-1944
Mailing address:
  • Phone: 985-674-1944
  • Fax: 985-674-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD.02730R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: