Provider Demographics
NPI:1730311531
Name:DONALD K WILLIAMS DO PC
Entity Type:Organization
Organization Name:DONALD K WILLIAMS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-660-9394
Mailing Address - Street 1:2310 N. CHERRY ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-991-3054
Mailing Address - Fax:509-926-4669
Practice Address - Street 1:2310 N. CHERRY ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-991-3054
Practice Address - Fax:509-926-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807137200Medicaid
ID807137200Medicaid
WAG8858149Medicare PIN
IDI29178Medicare UPIN