Provider Demographics
NPI:1205833951
Name:WILLIAMS, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:1701 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1319
Mailing Address - Country:US
Mailing Address - Phone:541-471-2701
Mailing Address - Fax:541-471-1166
Practice Address - Street 1:741 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1556
Practice Address - Country:US
Practice Address - Phone:541-471-2701
Practice Address - Fax:541-471-1166
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR107211Medicare ID - Type Unspecified
OR079413Medicare ID - Type Unspecified
ORG21869Medicare UPIN