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General NPI Number Information
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NPI Number | 1215124144
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Entity Type | Organization
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Legal Business Name | WILLIAMS CLINIC OF STILLWATER INC.
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 801 S WASHINGTON ST
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City | STILLWATER
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State | OK
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Zip | 74074-4541
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Country | US
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Telephone | 405-377-1121
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Fax | 405-624-9201
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Provider Business Mailing Address
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Address Line | 801 S WASHINGTON ST
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City | STILLWATER
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State | OK
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Zip | 74074-4541
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Country | US
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Telephone | 405-377-1121
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Fax | 405-624-9201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIDNEY DALTON WILLIAMS JR.
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Credential | M.D.
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Telephone | 450-377-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OK9680
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License Number State | OK
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