Provider Demographics
NPI:1174530810
Name:WILLIAMS, DEBRA JEAN (DPM PC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619
Mailing Address - Country:US
Mailing Address - Phone:315-493-6949
Mailing Address - Fax:315-493-6949
Practice Address - Street 1:720 STATE STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-6949
Practice Address - Fax:315-493-6949
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0044661213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T01480Medicare UPIN
1056500001Medicare NSC
NY51743BMedicare PIN