Provider Demographics
NPI:1063596278
Name:WILLIAMS, RICK W (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1106 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9164
Practice Address - Country:US
Practice Address - Phone:417-581-3548
Practice Address - Fax:417-581-6164
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3N24207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202885810Medicaid
MO302013268Medicare PIN
MO030013230Medicare PIN
MO202885810Medicaid