Provider Demographics
NPI:1487685020
Name:WILLIAMS, TERENCE MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4001
Mailing Address - Country:US
Mailing Address - Phone:918-245-9675
Mailing Address - Fax:918-245-9679
Practice Address - Street 1:20 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4001
Practice Address - Country:US
Practice Address - Phone:918-245-9675
Practice Address - Fax:918-245-9679
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118800DMedicaid
OK100118800DMedicaid
E16022Medicare UPIN