Provider Demographics
NPI:1124110283
Name:WILLIAMS, TODD E (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
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:PO BOX 5820
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-5820
Mailing Address - Country:US
Mailing Address - Phone:505-327-1754
Mailing Address - Fax:505-327-1840
Practice Address - Street 1:2300 E 30TH ST BLDG B
Practice Address - Street 2:STE 103
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8991
Practice Address - Country:US
Practice Address - Phone:505-327-1754
Practice Address - Fax:505-327-1840
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-3122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB7802Medicaid
NMB7802Medicaid
NMH24196Medicare UPIN