Provider Demographics
NPI:1407849433
Name:WILLIAMS, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2480 MARINA CIR UNIT 114
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4875
Mailing Address - Country:US
Mailing Address - Phone:920-360-6282
Mailing Address - Fax:920-283-1278
Practice Address - Street 1:2480 MARINA CIR UNIT 114
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4875
Practice Address - Country:US
Practice Address - Phone:920-360-6282
Practice Address - Fax:920-283-1278
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI44378-020208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34203400Medicaid
WA005600416Medicare PIN
WI34203400Medicaid