Healthcare Provider Details

I. General information

NPI: 1134372584
Provider Name (Legal Business Name): ZACHARY R WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EXCHANGE BLVD APT 330
ROCHESTER NY
14608-2780
US

IV. Provider business mailing address

310 EXCHANGE BLVD APT 330
ROCHESTER NY
14608-2780
US

V. Phone/Fax

Practice location:
  • Phone: 801-455-4581
  • Fax:
Mailing address:
  • Phone: 801-581-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7154790-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number258290
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number258290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: