Provider Demographics
NPI:1003175258
Name:WILLIAMS, ELWOOD FRAY III (MD)
Entity Type:Individual
Prefix:
First Name:ELWOOD
Middle Name:FRAY
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7546
Mailing Address - Country:US
Mailing Address - Phone:918-579-2791
Mailing Address - Fax:918-579-2799
Practice Address - Street 1:8803 S 101ST EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7546
Practice Address - Country:US
Practice Address - Phone:918-579-2791
Practice Address - Fax:918-579-2799
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK32763207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200712470AMedicaid