Healthcare Provider Details

I. General information

NPI: 1245057306
Provider Name (Legal Business Name): PEGGY SUE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLAZA RM 305
MADILL OK
73446-2273
US

IV. Provider business mailing address

110 MAIN ST
MILBURN OK
73450
US

V. Phone/Fax

Practice location:
  • Phone: 580-257-2002
  • Fax:
Mailing address:
  • Phone: 580-898-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: