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General NPI Number Information
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NPI Number | 1740242098
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Entity Type | Organization
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Legal Business Name | BRUCE P WILLIAMS MD PC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4133 GATEWAY BLVD SUITE 210
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City | NEWBURGH
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State | IN
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Zip | 47630-7918
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Country | US
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Telephone | 812-853-5671
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Fax | 812-853-5697
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Provider Business Mailing Address
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Address Line | 4133 GATEWAY BLVD SUITE 210
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City | NEWBURGH
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State | IN
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Zip | 47630-7918
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Country | US
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Telephone | 812-853-5671
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Fax | 812-853-5697
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE PARMER WILLIAMS
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Credential | MD
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Telephone | 812-853-5671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01025479B
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License Number State | IN
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