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General NPI Number Information
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NPI Number | 1508009424
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Entity Type | Organization
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Legal Business Name | GULF COAST RADIOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 1680 W 2ND ST
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City | GULF SHORES
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State | AL
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Zip | 36542-3442
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Country | US
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Telephone | 251-948-3420
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Fax | 251-948-3455
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Provider Business Mailing Address
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Address Line | 1680 W 2ND ST
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City | GULF SHORES
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State | AL
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Zip | 36542-3442
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Country | US
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Telephone | 251-948-3420
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Fax | 251-948-3455
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. JASON R WILLIAMS
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Credential | M.D.
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Telephone | 662-313-1392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD25102
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD25102
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License Number State | AL
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