MEDICARE: DR. MATTHEW E WILLIAMSON D.O.

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	2085R0202X	Diagnostic Radiology Physician	0102206546	VA
2	2085R0202X	Diagnostic Radiology Physician	O-334	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467428540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW E WILLIAMSON D.O.

Provider Business Mailing Address
First Line	:	2265 E SUNNYSIDE RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7598
Country	:	US
Telephone Number	:	208-542-5000
Fax Number	:	208-542-5151

Provider Business Practice Location Address
First Line	:	777 HOSPITAL WAY
Second Line	:	BLDG B
City	:	POCATELLO
State	:	ID
Zip	:	83201-5175
Country	:	US
Telephone Number	:	208-239-1000
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	09/11/2023

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Directions to “ DR. MATTHEW E WILLIAMSON D.O.” Practice Location

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