Provider Demographics
NPI:1336137728
Name:WILLIAMS, ROBERT C (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402319
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2319
Mailing Address - Country:US
Mailing Address - Phone:479-709-7399
Mailing Address - Fax:479-709-7053
Practice Address - Street 1:702 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-2430
Practice Address - Country:US
Practice Address - Phone:918-962-2442
Practice Address - Fax:918-962-3895
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN5898207Q00000X
OK2011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR108273003Medicaid
OK100134340BMedicaid
ARE16485Medicare UPIN
OKOK700975Medicare PIN
AR53001Medicare PIN