Provider Demographics
NPI:1144231945
Name:WILLIAMS, TAMI O (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:O
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 2076
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-2076
Mailing Address - Country:US
Mailing Address - Phone:573-334-0515
Mailing Address - Fax:573-334-1122
Practice Address - Street 1:3262 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2609
Practice Address - Country:US
Practice Address - Phone:573-334-0515
Practice Address - Fax:573-334-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156016207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO434499OtherHEALTHLINK PROVIDER #
MO1863120OtherFIRST HEALTH PROVIDER #
MO128569OtherBLUE CROSS PROVIDER #
MO434499OtherHEALTHLINK PROVIDER #