Provider Demographics
NPI: | 1639193766 |
---|---|
Name: | WILLIAMS, BARRY RALPH (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | BARRY |
Middle Name: | RALPH |
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: | 858 EASTERN BYP |
Mailing Address - Street 2: | |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40475-2512 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-626-0072 |
Mailing Address - Fax: | 859-626-9684 |
Practice Address - Street 1: | 858 EASTERN BYP |
Practice Address - Street 2: | |
Practice Address - City: | RICHMOND |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40475-2512 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-626-0072 |
Practice Address - Fax: | 859-626-9684 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-26 |
Last Update Date: | 2012-12-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 38492 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 4000501 | Other | MEDICARE LAB GRP |
KY | 37903705 | Other | MEDICAID LAB GRP |
KY | 64089824 | Medicaid | |
KY | 0326322 | Medicare ID - Type Unspecified | |
KY | 0092734 | Medicare PIN | |
KY | 64089824 | Medicaid | |
I06253 | Medicare UPIN |