Provider Demographics
NPI:1780688010
Name:WILLIAMS, DAVID BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BERNARD
Last Name:WILLIAMS
Suffix:
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:403 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1153
Practice Address - Country:US
Practice Address - Phone:606-549-8244
Practice Address - Fax:606-549-0354
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1389596OtherUMWA
KYC92478OtherCUMBERLAND HEALTHCARE
KYP01428673OtherRR MEDICARE
KY64260714Medicaid
KYK051301Medicare PIN
KY000000529382OtherANTHEM
KYC13108OtherHUMANA
KY64260714Medicaid