Provider Demographics
NPI:1548417272
Name:CHARLES T WILLIAMS MD PC
Entity Type:Organization
Organization Name:CHARLES T WILLIAMS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-848-8833
Mailing Address - Street 1:PO BOX 14428
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85063-4428
Mailing Address - Country:US
Mailing Address - Phone:623-848-8833
Mailing Address - Fax:623-848-8227
Practice Address - Street 1:9150 W INDIAN SCHOOL RD
Practice Address - Street 2:UNIT 8, SUITE 131
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2384
Practice Address - Country:US
Practice Address - Phone:623-848-8833
Practice Address - Fax:623-848-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12804208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0033830OtherBCBS OF AZ
AZ229303Medicaid
AZAZ0033830OtherBCBS OF AZ
AZ229303Medicaid