Provider Demographics
NPI:1437592821
Name:WILLIAMS, THORNTON GAVIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THORNTON
Middle Name:GAVIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3900
Practice Address - Street 1:10085 DOUBLE R BLVD STE 205
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3854
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-7205
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV17237208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation