Provider Demographics
NPI:1962450635
Name:WILLIAMS, RICHARD MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MALCOLM
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 1:10455 EMMA LN NW
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49676-8608
Mailing Address - Country:US
Mailing Address - Phone:360-656-6396
Mailing Address - Fax:231-346-6255
Practice Address - Street 1:10455 EMMA LN NW
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:MI
Practice Address - Zip Code:49676-8608
Practice Address - Country:US
Practice Address - Phone:360-656-6396
Practice Address - Fax:231-346-6255
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTM004962085R0202X
IN01069024A2085R0202X
MI24062085R0202X
WAMD606687132085R0202X
VA01012427732085R0202X
IL0360514962085R0202X
PAMD4418462085R0202X
AZ261652085R0202X
MDD00821802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501842OtherAHCCCS
AZ1Z7105OtherHEALTHNET
AZAZ0831550OtherBCBS
AZAZ0831550OtherBCBS
AZ1Z7105OtherHEALTHNET