Provider Demographics
NPI:1427064328
Name:WILLIAMS, DAVID V (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
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 239
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0239
Mailing Address - Country:US
Mailing Address - Phone:360-736-0771
Mailing Address - Fax:360-736-4867
Practice Address - Street 1:208 CENTRALIA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4007
Practice Address - Country:US
Practice Address - Phone:360-736-0771
Practice Address - Fax:360-736-4867
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL00430OtherREGENCE
WA1337906Medicaid
WAGAB08771Medicare PIN
WAL00430OtherREGENCE