Provider Demographics
NPI:1245057306
Name:WILLIAMS, PEGGY SUE
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBURN
Mailing Address - State:OK
Mailing Address - Zip Code:73450
Mailing Address - Country:US
Mailing Address - Phone:580-898-2311
Mailing Address - Fax:
Practice Address - Street 1:100 PLAZA RM 305
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-2273
Practice Address - Country:US
Practice Address - Phone:580-257-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist