Provider Demographics
NPI:1275528895
Name:WILLIAMS, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17067 S OUTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2165
Mailing Address - Country:US
Mailing Address - Phone:816-331-4000
Mailing Address - Fax:816-331-3626
Practice Address - Street 1:17067 S OUTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:816-331-4000
Practice Address - Fax:816-331-3626
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD R9H36207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100452520AMedicaid
MO203144217Medicaid
MO1275528895Medicaid
MOB57646Medicare UPIN
MO1275528895Medicaid