Provider Demographics
NPI:1396741369
Name:WILLIAMS, JAMES MARSHALL (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MARSHALL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:317-957-2705
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6977
Practice Address - Country:US
Practice Address - Phone:317-247-0201
Practice Address - Fax:317-481-6756
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02000581A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000081247OtherBLUE CROSS BLUE SHIELD
IN100318810Medicaid
INP01456978OtherRAIL ROAD PTAN
IN266180477Medicare PIN
IN000000081247OtherBLUE CROSS BLUE SHIELD