Provider Demographics
NPI:1417907791
Name:WILLIAMS, BRUCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E LEE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2368
Mailing Address - Country:US
Mailing Address - Phone:334-348-8818
Mailing Address - Fax:334-393-8773
Practice Address - Street 1:805 E LEE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2368
Practice Address - Country:US
Practice Address - Phone:334-348-8818
Practice Address - Fax:334-393-8773
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000028379Medicaid
AL51028379OtherBLUE CROSS BLUE SHIELD
AL000028379Medicaid
AL000028379Medicare PIN
AL110002408Medicare PIN