Provider Demographics
NPI:1770519753
Name:WILLIAMS, ALAN LOUDON (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:LOUDON
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 1:8463 POINTE RD N
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4305
Mailing Address - Country:US
Mailing Address - Phone:360-371-0902
Mailing Address - Fax:360-371-0188
Practice Address - Street 1:8463 POINTE RD N
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4305
Practice Address - Country:US
Practice Address - Phone:360-371-0902
Practice Address - Fax:360-371-0188
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000201282085N0700X, 2085R0202X
MO1071112085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB57624Medicare UPIN
MOP00676650Medicare PIN
MO152360036Medicare PIN