Healthcare Provider Details

I. General information

NPI: 1861886491
Provider Name (Legal Business Name): PAUL WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 10/06/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

IV. Provider business mailing address

317 GLASGOW DR
LAFAYETTE LA
70508-6589
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-3201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number328867
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: