Healthcare Provider Details

I. General information

NPI: 1336137728
Provider Name (Legal Business Name): ROBERT C WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W BROADWAY ST
SPIRO OK
74959-2430
US

IV. Provider business mailing address

PO BOX 402319
ATLANTA GA
30384-2319
US

V. Phone/Fax

Practice location:
  • Phone: 918-962-2442
  • Fax: 918-962-3895
Mailing address:
  • Phone: 479-709-7399
  • Fax: 479-709-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN5898
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: