Provider Demographics
NPI:1104841501
Name:WILLIAMS, DEAN J (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:J
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 252
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0252
Mailing Address - Country:US
Mailing Address - Phone:720-505-1753
Mailing Address - Fax:
Practice Address - Street 1:4943 STATE HIGHWAY 52 STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80514-9101
Practice Address - Country:US
Practice Address - Phone:720-505-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105493207P00000X
TN031229207P00000X
PAMD418570207P00000X
WV18584207P00000X
NE26916207P00000X
ND15305207P00000X
WI61394-20207P00000X
IAMD-48063207P00000X
CO48666207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105493Medicaid
IL036105493Medicaid
IL207772Medicare PIN