Provider Demographics
NPI:1407483852
Name:WILLIAMS, BEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CELEBRATION DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2664
Mailing Address - Country:US
Mailing Address - Phone:304-838-3084
Mailing Address - Fax:585-276-2430
Practice Address - Street 1:41810 N VENTURE DR UNIT D136
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3174
Practice Address - Country:US
Practice Address - Phone:304-838-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71569207ND0101X, 207N00000X
KYSTUDENT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine