Healthcare Provider Details

I. General information

NPI: 1831304906
Provider Name (Legal Business Name): RONALD GEORGE WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 12TH AVE NE
OLYMPIA WA
98506-5218
US

IV. Provider business mailing address

3504 12TH AVE NE
OLYMPIA WA
98506-5218
US

V. Phone/Fax

Practice location:
  • Phone: 360-252-3801
  • Fax:
Mailing address:
  • Phone: 360-252-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number36151
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00030788
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD00030788
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: