Provider Demographics
NPI:1669455580
Name:WILLIAMS, KATHERINE KALLMEYER (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KALLMEYER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 WILLIAMS WAY STE A
Mailing Address - Street 2:PO BOX 1270
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2065
Mailing Address - Country:US
Mailing Address - Phone:435-259-7121
Mailing Address - Fax:435-259-3112
Practice Address - Street 1:476 WILLIAMS WAY
Practice Address - Street 2:STE A
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2065
Practice Address - Country:US
Practice Address - Phone:435-259-7121
Practice Address - Fax:435-259-3112
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109647-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$003Medicaid
UTHI9705Medicare UPIN
UT$$$$$$$$$003Medicaid