Provider Demographics
NPI:1407816341
Name:WILLIAMS, SCOTT SHIELDS (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:SHIELDS
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 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-899-0767
Practice Address - Fax:480-899-1145
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM09712080P0210X
LAMD.2032622080P0210X
AZ52243207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173607601Medicaid
LA1755095Medicaid
MS02822278Medicaid
AZ148504Medicaid
AZ148504Medicaid
MS02822278Medicaid