Provider Demographics
NPI:1770547671
Name:WILLIAMS, KAREN R (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
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 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:360-896-6944
Mailing Address - Fax:360-254-2894
Practice Address - Street 1:417 SE 164TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8943
Practice Address - Country:US
Practice Address - Phone:360-896-6944
Practice Address - Fax:360-254-2894
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036044207R00000X
ORMD15293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR049619Medicaid
WA8429433Medicaid
WA135140OtherWA LABOR & INDUSTRIES
WA135140OtherWA LABOR & INDUSTRIES
OR049619Medicaid