1336412949 NPI number — WAYNE E. WILLIAMS D.O. P.L.L.C.

Table of content: (NPI 1336412949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336412949 NPI number — WAYNE E. WILLIAMS D.O. P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE E. WILLIAMS D.O. P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336412949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 722788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-9117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-694-5496
Provider Business Mailing Address Fax Number:
405-366-8286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N PORTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-6404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-307-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
918-207-7893

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  5131 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 5131 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)