Provider Demographics
NPI:1487631842
Name:WILLIAMS, ROGER T (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:T
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-0010
Mailing Address - Country:US
Mailing Address - Phone:928-532-5838
Mailing Address - Fax:801-423-3309
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD BLDG 3
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7111
Practice Address - Country:US
Practice Address - Phone:284-325-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173758Medicaid
AZWDBXJ05Medicare PIN
F35346Medicare UPIN