Provider Demographics
NPI:1114113263
Name:WILLIAMS, JUDITH LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 W BAYAUD AVE
Mailing Address - Street 2:#10
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2022
Mailing Address - Country:US
Mailing Address - Phone:804-366-5206
Mailing Address - Fax:
Practice Address - Street 1:12610 W BAYAUD AVE
Practice Address - Street 2:#10
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2022
Practice Address - Country:US
Practice Address - Phone:303-501-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01330224Medicaid
F48149Medicare UPIN
F-435-8Medicare PIN