Provider Demographics
NPI:1194764290
Name:WILLIAMS, JASON L (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
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 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6324
Practice Address - Country:US
Practice Address - Phone:501-202-1902
Practice Address - Fax:501-202-1512
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5433207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
07110012100OtherQUAL CHOICE
5358014OtherCIGNA
5H032OtherBCBS
1194764240OtherMERCY HEALTH
1194764240OtherMERCY HEALTH
07110012100OtherQUAL CHOICE