Healthcare Provider Details

I. General information

NPI: 1649509704
Provider Name (Legal Business Name): RICHARD JUDD WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SILVER REEF RD
LEEDS UT
84746-0729
US

IV. Provider business mailing address

PO BOX 460729 560 SILVER REEF RD
LEEDS UT
84746-0729
US

V. Phone/Fax

Practice location:
  • Phone: 307-679-0605
  • Fax:
Mailing address:
  • Phone: 307-679-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number153443-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: