Provider Demographics
NPI:1811966385
Name:WILLIAMS, RANDAL E (PA-C)
Entity type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S PERRY ST
Mailing Address - Street 2:SUITE: 101B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2668
Mailing Address - Country:US
Mailing Address - Phone:303-688-2228
Mailing Address - Fax:303-663-0640
Practice Address - Street 1:1001 S PERRY ST
Practice Address - Street 2:SUITE: 101B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2668
Practice Address - Country:US
Practice Address - Phone:303-688-2228
Practice Address - Fax:303-663-0640
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00965363AM0700X
COPA.0001279363AM0700X
NMPA2010-0073363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71577289Medicaid
KS200362810AMedicaid
CO95256237Medicaid