MEDICARE: WARREN KEITH WILLIAMSON P.A.

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	2892	AZ

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	:	1912951823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN KEITH WILLIAMSON P.A.

Provider Business Mailing Address
First Line	:	220 SOUTH 12TH AVENUE
Second Line	:	MARICOPA COUNTY HEALTH CARE FOR THE HOMELESS
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3101
Country	:	US
Telephone Number	:	602-372-2117
Fax Number	:	602-372-2120

Provider Business Practice Location Address
First Line	:	220 SOUTH 12TH AVENUE
Second Line	:	MARICOPA COUNTY HEALTH CARE FOR THE HOMELESS
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3101
Country	:	US
Telephone Number	:	602-372-2117
Fax Number	:	602-372-2120

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	01/12/2012

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