Provider Demographics
NPI:1659479061
Name:WILLIAMS, THOMAS EDWIN (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32223 BRANT LN
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-2205
Mailing Address - Country:US
Mailing Address - Phone:660-947-2442
Mailing Address - Fax:
Practice Address - Street 1:630 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1076
Practice Address - Country:US
Practice Address - Phone:660-265-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243662434Medicaid
MOMA1231015Medicare PIN
MOF41079Medicare UPIN
MO010050097Medicare ID - Type Unspecified