Provider Demographics
NPI:1235127606
Name:WILLIAMS, JAMES MCKINLEY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MCKINLEY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 3RD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3269
Mailing Address - Country:US
Mailing Address - Phone:567-201-2890
Mailing Address - Fax:567-201-2893
Practice Address - Street 1:605 3RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3269
Practice Address - Country:US
Practice Address - Phone:567-201-2890
Practice Address - Fax:567-201-2893
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH088507207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062143Medicaid
OK100095310BMedicaid
OKA03569Medicare UPIN
OHH111860Medicare PIN
OH0062143Medicaid