Provider Demographics
NPI:1225067606
Name:WILLIAMS, RAFAEL M (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:M
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:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-1968
Mailing Address - Country:US
Mailing Address - Phone:307-733-5676
Mailing Address - Fax:307-734-0734
Practice Address - Street 1:5235 HHR RANCH RD
Practice Address - Street 2:SNAKE RIVER ORTHOPEDICS
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-5235
Practice Address - Country:US
Practice Address - Phone:307-733-5676
Practice Address - Fax:307-734-0734
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83929207X00000X
WY7868A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06542ZMedicare ID - Type Unspecified
H36873Medicare UPIN