Healthcare Provider Details

I. General information

NPI: 1144231945
Provider Name (Legal Business Name): TAMI O WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 LEXINGTON AVE
CAPE GIRARDEAU MO
63701-2609
US

IV. Provider business mailing address

PO BOX 2076
CAPE GIRARDEAU MO
63702-2076
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-0515
  • Fax: 573-334-1120
Mailing address:
  • Phone: 573-334-0515
  • Fax: 573-334-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2000156016
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: