Provider Demographics
NPI:1457685331
Name:WILLIAMS, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
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 1:6005 PARK AVE STE 624B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0214
Mailing Address - Country:US
Mailing Address - Phone:901-682-1100
Mailing Address - Fax:019-682-6915
Practice Address - Street 1:6005 PARK AVE STE 624B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-682-1100
Practice Address - Fax:019-682-6915
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241508207R00000X
FLME124723207W00000X, 207WX0107X
NMRS2013-0106207W00000X
TN56690207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA241508OtherMA LICENSE
FLME124723OtherSTATE LICENSE
FLME124723OtherSTATE LICENSE