Healthcare Provider Details

I. General information

NPI: 1629415476
Provider Name (Legal Business Name): JON P WILLIAMS D.O., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MIAMI VALLEY DR STE 550
CENTERVILLE OH
45459-1298
US

IV. Provider business mailing address

2300 MIAMI VALLEY DR STE 550
CENTERVILLE OH
45459-1298
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-7500
  • Fax:
Mailing address:
  • Phone: 937-438-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number02004573A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number02004573A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: