MEDICARE: MORIAH J. WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1023451606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORIAH J. WILLIAMS

Provider Business Mailing Address
First Line	:	PO BOX 22748
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-2748
Country	:	US
Telephone Number	:	505-577-0479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4052
Country	:	US
Telephone Number	:	505-577-0479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	08/05/2015

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