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General NPI Number Information
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NPI Number | 1710086749
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Entity Type | Individual
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Provider Name | JERRY K WILLIAMS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2301 7TH ST SUITE B
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City | LAS VEGAS
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State | NM
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Zip | 87701-4966
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Country | US
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Telephone | 505-426-1200
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Fax | 505-426-1202
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Provider Business Mailing Address
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Address Line | PO BOX 3861
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City | LAS VEGAS
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State | NM
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Zip | 87701-6861
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Country | US
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Telephone | 505-426-1200
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Fax | 505-426-1202
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 94-167
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License Number State | NM
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