Provider Demographics
NPI:1942246913
Name:WILLIAMS, TERENCE DALE (PA)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:DALE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7280
Mailing Address - Country:US
Mailing Address - Phone:623-374-7774
Mailing Address - Fax:855-420-6361
Practice Address - Street 1:2640 W BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6492
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970001480Medicare PIN
CTP00083093Medicare PIN
P99218Medicare UPIN