Provider Demographics
NPI:1972675817
Name:WILLIAMS, RICHARD BLISS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BLISS
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:PO BOX 700863
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0863
Mailing Address - Country:US
Mailing Address - Phone:918-493-2642
Mailing Address - Fax:
Practice Address - Street 1:2608 E 74TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5557
Practice Address - Country:US
Practice Address - Phone:918-493-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK140662085R0202X
AZ337732085R0202X
IDM-96802085R0202X
CAC227302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology