Provider Demographics
NPI:1972588440
Name:WILLIAMS, JANICE L (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
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 1:2 HALSTED CIR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3184
Mailing Address - Country:US
Mailing Address - Phone:479-721-4414
Mailing Address - Fax:216-208-1291
Practice Address - Street 1:2 HALSTED CIR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-721-4414
Practice Address - Fax:216-208-1291
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10962207Q00000X
OK20285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG54875Medicare UPIN