Provider Demographics
NPI:1609872332
Name:WILLIAMS MD, DOUGLAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:WILLIAMS MD
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 1:6850 HOHMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1410
Mailing Address - Country:US
Mailing Address - Phone:219-931-7509
Mailing Address - Fax:
Practice Address - Street 1:6850 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1410
Practice Address - Country:US
Practice Address - Phone:219-931-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068963207W00000X
IN01035921A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100214680Medicaid
IL523280Medicare PIN
IN100214680Medicaid
ILL67176Medicare ID - Type Unspecified