Provider Demographics
NPI:1710280565
Name:DR RYAN RAYMOND WILLIAMS MD PC
Entity Type:Organization
Organization Name:DR RYAN RAYMOND WILLIAMS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-327-2484
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:190 S 100 W
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1512
Mailing Address - Country:US
Mailing Address - Phone:435-327-2484
Mailing Address - Fax:435-438-6352
Practice Address - Street 1:190 SOUTH 100 WEST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-1512
Practice Address - Country:US
Practice Address - Phone:435-327-2484
Practice Address - Fax:435-438-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT338570-12052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty