Provider Demographics
NPI:1396775706
Name:WILLIAMS, JOHN STEWART (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEWART
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 3180
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80201-3180
Mailing Address - Country:US
Mailing Address - Phone:800-683-9930
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:3455 LUTHERAN PKWY
Practice Address - Street 2:STE 290
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6028
Practice Address - Country:US
Practice Address - Phone:303-467-1467
Practice Address - Fax:405-948-6507
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68578849Medicaid
COWI10317OtherANTHEM BCBS OF CO
COB3538Medicare PIN
D06894Medicare UPIN