Provider Demographics
NPI:1174511711
Name:WILLIAMS, DANIEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
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 1:50020 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-5520
Mailing Address - Country:US
Mailing Address - Phone:308-631-3258
Mailing Address - Fax:
Practice Address - Street 1:50020 LEISURE LN
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-5520
Practice Address - Country:US
Practice Address - Phone:308-631-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43612207L00000X
NE25996207L00000X
WY7824A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84228725Medicaid
WY121550700Medicaid
WYW24110Medicare PIN
COP00270752Medicare PIN
WY121550700Medicaid
COI34943Medicare UPIN