Provider Demographics
NPI:1194082057
Name:WILLIAMS, BLAKE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SE PLAZA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5697
Mailing Address - Country:US
Mailing Address - Phone:479-273-3376
Mailing Address - Fax:
Practice Address - Street 1:901 SE PLAZA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5697
Practice Address - Country:US
Practice Address - Phone:479-273-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9143207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR511270ZPU5Medicare UPIN