Provider Demographics
NPI:1770507931
Name:WILLIAMS, SIDNEY DALTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:DALTON
Last Name:WILLIAMS
Suffix:JR
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 1:801 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4541
Mailing Address - Country:US
Mailing Address - Phone:405-377-1121
Mailing Address - Fax:405-624-9201
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4541
Practice Address - Country:US
Practice Address - Phone:405-377-1121
Practice Address - Fax:405-624-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200343660AMedicaid
OKD42936Medicare UPIN