Provider Demographics
NPI:1245238468
Name:WILLIAMS, BILL M (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
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 1:1456 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2706
Mailing Address - Country:US
Mailing Address - Phone:307-672-5881
Mailing Address - Fax:307-672-1766
Practice Address - Street 1:1456 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2706
Practice Address - Country:US
Practice Address - Phone:307-672-5881
Practice Address - Fax:307-672-1766
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2364A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW301613Medicaid
WYW301613Medicare PIN
WYW301613Medicare ID - Type UnspecifiedPROVIDER NUMBER
WYW301613Medicaid