Provider Demographics
NPI:1477116820
Name:WILLIAMS, PAUL LOGAN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LOGAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 SE RIO DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3846
Mailing Address - Country:US
Mailing Address - Phone:515-868-2566
Mailing Address - Fax:
Practice Address - Street 1:11815 SW KING JAMES PL STE 60
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-2479
Practice Address - Country:US
Practice Address - Phone:503-639-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP215948213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery