Provider Demographics
NPI:1427247808
Name:ROBERT L WILLIAMS, D.O.,P.C.
Entity type:Organization
Organization Name:ROBERT L WILLIAMS, D.O.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-356-1004
Mailing Address - Street 1:4419 S CRYSLER AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5948
Mailing Address - Country:US
Mailing Address - Phone:816-356-1004
Mailing Address - Fax:816-743-0775
Practice Address - Street 1:4419 S CRYSLER AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5948
Practice Address - Country:US
Practice Address - Phone:816-356-1004
Practice Address - Fax:816-743-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9506208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01987019OtherBLUE SHIELD
MO08085013OtherBLUE CARE
MO0108272OtherUNITED HEALTH CARE
MO0108272OtherUNITED HEALTH CARE
MOC52298Medicare UPIN
MO5134252Medicare PIN