Provider Demographics
NPI:1962902353
Name:WILLIAMS, DANA P
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 OLIVE ST STE 904
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1431
Mailing Address - Country:US
Mailing Address - Phone:314-421-9600
Mailing Address - Fax:314-421-9603
Practice Address - Street 1:906 OLIVE ST STE 904
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1431
Practice Address - Country:US
Practice Address - Phone:314-421-9600
Practice Address - Fax:314-421-9603
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO193400000X2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine