Healthcare Provider Details

I. General information

NPI: 1205897055
Provider Name (Legal Business Name): BASIMA WILLIAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 HIGHWAY N
DARDENNE PRAIRIE MO
63368-7014
US

IV. Provider business mailing address

1551 WALL ST SUITE 310
SAINT CHARLES MO
63303-3539
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5699
  • Fax: 636-669-2401
Mailing address:
  • Phone: 636-669-2268
  • Fax: 636-669-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005036218
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: