Basic Information
| Provider Information | |||||||||
| NPI: | 1811906902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 STATE ST | ||||||||
| Address2: | |||||||||
| City: | OGDENSBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136693347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153939269 | ||||||||
| FaxNumber: | 3153933541 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 STATE STREET | ||||||||
| Address2: | |||||||||
| City: | OGDENSBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153939269 | ||||||||
| FaxNumber: | 3153933541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 155781-1 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 155781-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.