Healthcare Provider Details

I. General information

NPI: 1487069100
Provider Name (Legal Business Name): MATTHEW WILLIAMSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 83RD ST
LINCOLN NE
68505-2094
US

IV. Provider business mailing address

1150 N 83RD ST
LINCOLN NE
68505-2094
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4485
  • Fax: 402-483-5372
Mailing address:
  • Phone: 402-483-4485
  • Fax: 402-483-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2014019083
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number366
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: