Provider Demographics
NPI:1114991155
Name:WILLIAMS, CANDYCE (MD)
Entity Type:Individual
Prefix:
First Name:CANDYCE
Middle Name:
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:PO BOX 15667
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5667
Mailing Address - Country:US
Mailing Address - Phone:602-806-7610
Mailing Address - Fax:602-704-6054
Practice Address - Street 1:444 W OSBORN RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3817
Practice Address - Country:US
Practice Address - Phone:602-806-7610
Practice Address - Fax:602-704-6054
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21064207R00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117467Medicaid
AZE71088Medicare UPIN
AZZ66431Medicare ID - Type Unspecified