Provider Demographics
NPI:1346627551
Name:WILLIAMS, ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
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 1:16100 NW CORNELL RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7334
Mailing Address - Country:US
Mailing Address - Phone:503-878-8885
Mailing Address - Fax:971-297-1360
Practice Address - Street 1:16100 NW CORNELL RD STE 220
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7334
Practice Address - Country:US
Practice Address - Phone:503-878-8885
Practice Address - Fax:971-297-1360
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO.OP.61107091-IMLC2084P0800X
UT12573352-12042084P0800X
AZ0071172084P0800X
390200000X
ORDO1910282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007117OtherOSTEOPATHIC PHYSICIAN & SURGEON
WADO.OP.61107091-IMLCOtherOSTEOPATHIC PHYSICIAN & SURGEON
UT12573352-8904OtherOSTEOPATHIC CONTROLLED SUBSTANCE
AK190850OtherOSTEOPATHIC PHYSICIAN COURTESY LICENSE
UT12573352-1204OtherOSTEOPATHIC PHYSICIAN & SURGEON