MEDICARE: JEFFREY WILLIAMS PAC

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	363A00000X	Physician Assistant	1063	OK

General Provider Information

NPI Number	:	1609853696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WILLIAMS PAC

Provider Business Mailing Address
First Line	:	1001 N COUNTRY CLUB RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2847
Country	:	US
Telephone Number	:	580-421-4570
Fax Number	:	580-924-7215

Provider Business Practice Location Address
First Line	:	1600 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2128
Country	:	US
Telephone Number	:	580-920-2100
Fax Number	:	580-924-7215

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	05/21/2008

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Directions to “ JEFFREY WILLIAMS PAC” Practice Location

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