Provider Demographics
NPI:1982639712
Name:WILLIAMS, LARRY V (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:V
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 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-273-7700
Mailing Address - Fax:812-273-2827
Practice Address - Street 1:445 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1607
Practice Address - Country:US
Practice Address - Phone:812-273-7700
Practice Address - Fax:812-273-2827
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023516207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100148550AMedicaid
IN000000042196OtherANTHEM BCBS
110184012OtherMEDICARE RAILROAD
265769OtherFEDERAL BLACK LUNG
IN410013POtherSIHO
4370909OtherAETNA
265769OtherFEDERAL BLACK LUNG
IN410013POtherSIHO
110184012OtherMEDICARE RAILROAD
IN110184012Medicare PIN