Healthcare Provider Details

I. General information

NPI: 1295269348
Provider Name (Legal Business Name): JOSHUA STANTON WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NW 1ST LN
LAMAR MO
64759-8105
US

IV. Provider business mailing address

29 NW 1ST LN # 2
LAMAR MO
64759-8105
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-5100
  • Fax:
Mailing address:
  • Phone: 417-681-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020014925
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: