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General NPI Number Information
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NPI Number | 1982604369
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Entity Type | Individual
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Provider Name | ROY JEROME WILLIAMS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 3409 UNION BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1127
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Country | US
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Telephone | 314-261-4834
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Fax | 314-383-3930
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Provider Business Mailing Address
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Address Line | PO BOX 23340
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City | SAINT LOUIS
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State | MO
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Zip | 63156-3340
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Country | US
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Telephone | 314-261-4834
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Fax | 314-383-3930
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R9968
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License Number State | MO
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