=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982639712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY V WILLIAMS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 04/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 CLIFTY DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47250-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-273-7700
-----------------------------------------------------
Fax | 812-273-2827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 189
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47250-0189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-273-7700
-----------------------------------------------------
Fax | 812-273-2827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 01023516
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------