Provider Demographics
NPI:1548959323
Name:WILLIAMS, LUCIAN REED
Entity type:Individual
Prefix:
First Name:LUCIAN
Middle Name:REED
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CALEB
Other - Middle Name:JOSEPH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S OSTEOPATHY AVE APT 203A
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1413
Mailing Address - Country:US
Mailing Address - Phone:336-705-8400
Mailing Address - Fax:
Practice Address - Street 1:200 S OSTEOPATHY AVE APT 203A
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1413
Practice Address - Country:US
Practice Address - Phone:336-705-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program