Provider Demographics
NPI:1982695987
Name:WILLIAMS, GERALD F (DO)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:F
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:SUITE T101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-363-4100
Mailing Address - Fax:816-363-8201
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:SUITE T101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-363-4100
Practice Address - Fax:816-363-8201
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31867207R00000X
KS05-36814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240384727Medicaid
MOE22788Medicare UPIN
MO5232226Medicare ID - Type UnspecifiedMEDICARE - MO AND KS