Healthcare Provider Details

I. General information

NPI: 1528741246
Provider Name (Legal Business Name): MARTHA BEATRIZ WILLIAMS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

52 BROOKE CT
MIDLAND GA
31820-4827
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1112
  • Fax:
Mailing address:
  • Phone: 405-706-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number2616
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: