MEDICARE: DR. JON P WILLIAMS D.O., PH.D.

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	2084N0400X	Neurology Physician	02004573A	IN
2	171000000X	Military Health Care Provider	02004573A	IN

General Provider Information

NPI Number	:	1629415476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON P WILLIAMS D.O., PH.D.

Provider Business Mailing Address
First Line	:	2300 MIAMI VALLEY DR STE 550
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1298
Country	:	US
Telephone Number	:	937-438-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MIAMI VALLEY DR STE 550
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1298
Country	:	US
Telephone Number	:	937-438-7500
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	12/17/2024

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