MEDICARE: DR. CHERYL G WILLIAMS 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	207Q00000X	Family Medicine Physician	113319	MO

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	:	1730187204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL G WILLIAMS D.O.

Provider Business Mailing Address
First Line	:	1011 S EAST ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1399
Country	:	US
Telephone Number	:	417-466-7191
Fax Number	:	417-466-3876

Provider Business Practice Location Address
First Line	:	1011 S EAST ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1331
Country	:	US
Telephone Number	:	417-466-7191
Fax Number	:	417-466-3876

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/06/2026

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