Provider Demographics
NPI:1326242447
Name:WILLIAMS, JASON RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RUSSELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:111 W MYRTLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1968
Mailing Address - Country:US
Mailing Address - Phone:251-943-9409
Mailing Address - Fax:251-943-9724
Practice Address - Street 1:111 W MYRTLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1968
Practice Address - Country:US
Practice Address - Phone:251-943-9409
Practice Address - Fax:251-943-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251022085R0202X
MS197282085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH78020Medicare UPIN