Provider Demographics
NPI:1093973984
Name:WILLIAMS, CHARLES BRUCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRUCE
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:510 ELYSIAN FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6776
Mailing Address - Country:US
Mailing Address - Phone:337-237-5781
Mailing Address - Fax:
Practice Address - Street 1:913 S COLLEGE RD STE 203
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3062
Practice Address - Country:US
Practice Address - Phone:337-280-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD04518R208800000X
LAMD.04518R208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology