Provider Demographics
NPI:1275575128
Name:WILLIAMS, JOE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
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 1:6801 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1441
Mailing Address - Country:US
Mailing Address - Phone:720-929-8300
Mailing Address - Fax:720-929-8444
Practice Address - Street 1:3260 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4406
Practice Address - Country:US
Practice Address - Phone:720-929-8300
Practice Address - Fax:720-929-8444
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO356277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31387560Medicaid
COG69610Medicare UPIN