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General NPI Number Information
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NPI Number | 1932106713
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Entity Type | Individual
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Provider Name | DOUGLAS STANLEY WILLIAMS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 9 AIRPORT RD
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City | BLACKFOOT
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State | ID
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Zip | 83221-1702
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Country | US
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Telephone | 208-785-6700
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Fax | 208-785-6767
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Provider Business Mailing Address
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Address Line | 9 AIRPORT RD
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City | BLACKFOOT
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State | ID
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Zip | 83221-1702
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Country | US
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Telephone | 208-785-6700
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Fax | 208-785-6767
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PD176R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P-156
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P-156
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License Number State | ID
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