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General NPI Number Information
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NPI Number | 1669443420
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Entity Type | Organization
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Legal Business Name | SHAUNA T WILLIAMS MD PA
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 1072 N LIBERTY ST #201
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City | BOISE
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State | ID
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Zip | 83704-8706
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Country | US
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Telephone | 208-377-2273
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Fax | 208-367-3059
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Provider Business Mailing Address
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Address Line | 1072 N LIBERTY ST #201
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City | BOISE
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State | ID
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Zip | 83704-8706
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Country | US
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Telephone | 208-377-2273
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Fax | 208-367-3059
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAUNA T WILLIAMS
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Credential | MD
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Telephone | 208-377-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M5849
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License Number State | ID
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