Provider Demographics
NPI:1619992708
Name:WILLIAMS, DOROTHY L (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4000
Mailing Address - Country:US
Mailing Address - Phone:801-486-3021
Mailing Address - Fax:801-485-6339
Practice Address - Street 1:2295 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4000
Practice Address - Country:US
Practice Address - Phone:801-486-3021
Practice Address - Fax:801-485-6339
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34676112052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD3505Medicaid
UTD3505Medicaid