MEDICARE: LISA WILLIAMS M.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	174400000X	Specialist	6662A	WY
2	207V00000X	Obstetrics & Gynecology Physician	6662A	WY

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	:	1750376083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 1000
Second Line	:	1443 BECK AVENUE
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-527-7811
Fax Number	:	307-527-7396

Provider Business Practice Location Address
First Line	:	1443 BECK AVENUE
Second Line	:
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-527-7811
Fax Number	:	307-527-7396

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/20/2019

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