Provider Demographics
NPI:1902896269
Name:WILLIAMS, ROBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
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 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-753-4614
Mailing Address - Fax:270-767-3623
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-753-4614
Practice Address - Fax:270-767-3623
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY406063842OtherRAILROAD MEDICARE
KY000000047080OtherANTHEM
KY64204811Medicaid
KY406063842OtherRAILROAD MEDICARE
KY64204811Medicaid