Provider Demographics
NPI:1033144621
Name:WILLIAMS, WILLIAM THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:
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 1:1654 COUNTY ROAD 120
Mailing Address - Street 2:
Mailing Address - City:HESPERUS
Mailing Address - State:CO
Mailing Address - Zip Code:81326-9752
Mailing Address - Country:US
Mailing Address - Phone:207-249-9945
Mailing Address - Fax:
Practice Address - Street 1:555 RIVERGATE STE B1-105
Practice Address - Street 2:C/O CURTIS POWERS-ACKLEY
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7470
Practice Address - Country:US
Practice Address - Phone:970-749-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32387207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF61959Medicare UPIN