Provider Demographics
NPI:1073553202
Name:WILLIAMS, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1031
Mailing Address - Country:US
Mailing Address - Phone:580-338-6515
Mailing Address - Fax:580-225-5423
Practice Address - Street 1:350 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3624
Practice Address - Country:US
Practice Address - Phone:580-461-1606
Practice Address - Fax:580-225-5423
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK239142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00165591OtherRAILRAOD MEDICARE
OK200039390AMedicaid
OK249772706Medicare PIN
OKP00165591OtherRAILRAOD MEDICARE