Provider Demographics
NPI:1578551008
Name:WILLIAMS, RUSSELL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALAN
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-583-5948
Mailing Address - Fax:502-583-1804
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 902
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3841
Practice Address - Country:US
Practice Address - Phone:502-583-5948
Practice Address - Fax:502-583-1804
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24718208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK209590-KOHMGOtherKY MEDICARE
KY64247182Medicaid
KY0932004Medicare PIN
KY64247182Medicaid
KY1274804Medicare PIN