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General NPI Number Information
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NPI Number | 1487631842
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Entity Type | Individual
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Provider Name | ROGER T WILLIAMS MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 1500 S WHITE MOUNTAIN RD BLDG 3
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City | SHOW LOW
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State | AZ
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Zip | 85901-7111
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Country | US
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Telephone | 284-325-8389
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | OVERGAARD
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State | AZ
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Zip | 85933-0010
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Country | US
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Telephone | 928-532-5838
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Fax | 801-423-3309
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 22260
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22260
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License Number State | AZ
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