Provider Demographics
NPI:1093788366
Name:WILLIAMS, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
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 1:2337 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2331
Mailing Address - Country:US
Mailing Address - Phone:913-381-6862
Mailing Address - Fax:913-381-4515
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-789-5560
Practice Address - Fax:913-381-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010265902083P0011X
KS04-129672083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261655227OtherEIN
KS481213502OtherEIN - KS
KSP00631884OtherRAILROAD MEDICARE PIN
MOP00666570OtherRAILROAD MCR PIN
KS100197910EMedicaid
MO205799703Medicaid
KSP00765438OtherRAILROAD PTAN
MOK67000011OtherMISSOURI MEDICARE PIN
MOK67000011OtherMISSOURI MEDICARE PIN
KSK672561AMedicare PIN
KSKA1093001Medicare PIN
MOP00666570OtherRAILROAD MCR PIN
MO205799703Medicaid