Provider Demographics
NPI:1376991182
Name:WILLIAMS, ROGER DALE VI
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:WILLIAMS
Suffix:VI
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MONTGOMERY BLVD NE
Mailing Address - Street 2:W128
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1422
Mailing Address - Country:US
Mailing Address - Phone:505-463-7175
Mailing Address - Fax:
Practice Address - Street 1:6300 MONTGOMERY BLVD NE
Practice Address - Street 2:W128
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1422
Practice Address - Country:US
Practice Address - Phone:505-463-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other