Provider Demographics
NPI:1124068366
Name:WILLIAMS, RANDAL A (MD)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:A
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 1:220 W VINITA AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-3805
Mailing Address - Country:US
Mailing Address - Phone:580-622-5451
Mailing Address - Fax:580-622-5480
Practice Address - Street 1:220 W VINITA AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-3805
Practice Address - Country:US
Practice Address - Phone:580-622-5451
Practice Address - Fax:580-622-5480
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK080158623OtherRAILROAD MEDICARE
OK175735100OtherUS DEPT OF LABOR
OK100137300BMedicaid
OK080158623OtherRAILROAD MEDICARE
OK100137300BMedicaid