Healthcare Provider Details

I. General information

NPI: 1366495459
Provider Name (Legal Business Name): TANYA MAILE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 400 W
SALT LAKE CITY UT
84101-2201
US

IV. Provider business mailing address

404 S 400 W
SALT LAKE CITY UT
84101-2201
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-0058
  • Fax:
Mailing address:
  • Phone: 801-364-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7844110-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: