Healthcare Provider Details

I. General information

NPI: 1700306867
Provider Name (Legal Business Name): JONATHAN PAUL WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY STE 200
O FALLON MO
63368-2207
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 636-916-7060
  • Fax: 636-916-9421
Mailing address:
  • Phone: 314-953-6300
  • Fax: 314-953-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2021028092
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number2021028092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: