Healthcare Provider Details

I. General information

NPI: 1952404196
Provider Name (Legal Business Name): WILLIAM B WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE SUITE 200
PORTLAND ME
04102-2362
US

IV. Provider business mailing address

335 BRIGHTON AVE SUITE 200
PORTLAND ME
04102-2362
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1122
  • Fax: 207-828-0188
Mailing address:
  • Phone: 207-828-1122
  • Fax: 207-828-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number012160
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: