Provider Demographics
NPI:1649509704
Name:WILLIAMS, RICHARD JUDD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JUDD
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 460729
Mailing Address - Street 2:560 SILVER REEF RD
Mailing Address - City:LEEDS
Mailing Address - State:UT
Mailing Address - Zip Code:84746-0729
Mailing Address - Country:US
Mailing Address - Phone:307-679-0605
Mailing Address - Fax:
Practice Address - Street 1:560 SILVER REEF RD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:UT
Practice Address - Zip Code:84746-0729
Practice Address - Country:US
Practice Address - Phone:307-679-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153443-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery