Provider Demographics
NPI:1942460183
Name:WILLIAMS, CHASE C (MD)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:C
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 1:414 CHURCH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7065
Mailing Address - Country:US
Mailing Address - Phone:208-263-1421
Mailing Address - Fax:208-263-4430
Practice Address - Street 1:414 CHURCH ST STE 206
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-7065
Practice Address - Country:US
Practice Address - Phone:208-263-1421
Practice Address - Fax:208-263-4430
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD6699307208600000X
IDM-12025208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery