Provider Demographics
NPI:1750408860
Name:WILLIAMS, LYSLE WESTLEY JR (MD)
Entity type:Individual
Prefix:DR
First Name:LYSLE
Middle Name:WESTLEY
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7203 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7777
Mailing Address - Country:US
Mailing Address - Phone:509-737-1880
Mailing Address - Fax:509-737-1879
Practice Address - Street 1:3000 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2922
Practice Address - Country:US
Practice Address - Phone:509-783-8700
Practice Address - Fax:509-783-2933
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2021-04-29
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8133837Medicaid
WAA42045Medicare UPIN