Provider Demographics
NPI:1780779413
Name:WILLIAMS, RONALD J (M D)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:M D
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 1267
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-748-0211
Mailing Address - Fax:360-740-4170
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-748-0211
Practice Address - Fax:360-740-4170
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022890207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1009WIOtherREGENCE
WA8286866Medicaid
WA0204846OtherLABOR & INDUSTRIES
P00308752OtherRAILROAD MEDICARE
G8858197Medicare PIN
WA1009WIOtherREGENCE