Provider Demographics
NPI:1962628107
Name:WILLIAMS, JILL ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANNETTE
Last Name:WILLIAMS
Suffix:
Gender:F
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 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-251-5165
Mailing Address - Fax:425-656-4028
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-251-5165
Practice Address - Fax:425-656-4028
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000415272081H0002X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA339491OtherL&I
WA4659WIOtherBLUE SHIELD # VM
WA8369886Medicaid
WAUS5533762OtherAETNA SPECIALIST PIN VM
WA339491OtherL&I
WAG86194Medicare UPIN
WA8369886Medicaid