Provider Demographics
NPI:1457362121
Name:WILLIAMS, EDWARD DONALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONALD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2159
Mailing Address - Country:US
Mailing Address - Phone:505-982-0123
Mailing Address - Fax:505-982-5714
Practice Address - Street 1:2019 GALISTEO ST STE K
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2159
Practice Address - Country:US
Practice Address - Phone:505-982-0123
Practice Address - Fax:505-982-5714
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10001192OtherLOVELACE HEALTH PLAN
NM201010782OtherPRESBYTERIAN HEALTH PLAN
NM52969Medicaid
NMNM025315OtherBLUE CROSS BLUE SHIELD
NMPROVP16761OtherMOLINA
NM480005324OtherRAILROAD MEDICARE
0656560001Medicare NSC
NM201010782OtherPRESBYTERIAN HEALTH PLAN
NM480005324OtherRAILROAD MEDICARE