Healthcare Provider Details

I. General information

NPI: 1326019621
Provider Name (Legal Business Name): PAUL MARTIN WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 UNIVERSITY DR S
FARGO ND
58103
US

IV. Provider business mailing address

400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-3300
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number43263
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number14930
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: