Provider Demographics
NPI:1699091629
Name:WILLIAMS, BENJAMIN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THOMAS
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 1:343 S VIA DE LOS CAMPOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7447
Mailing Address - Country:US
Mailing Address - Phone:520-245-1552
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH DEPT OF EMERGENCY
Practice Address - Street 2:30 NORTH 1900 EAST RM 1C026
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124541207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program