Provider Demographics
NPI:1316385529
Name:WILLIAMS, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:S
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6030 S RAINBOW BLVD STE D2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2548
Mailing Address - Country:US
Mailing Address - Phone:702-329-0229
Mailing Address - Fax:866-611-3024
Practice Address - Street 1:6030 S RAINBOW BLVD STE D2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2548
Practice Address - Country:US
Practice Address - Phone:702-329-0229
Practice Address - Fax:866-611-3024
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204047208600000X
NV19934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV75523OtherPTAN
NV1316385529Medicaid