Provider Demographics
NPI:1447463724
Name:WILLIAMS, DOUGLAS WAYNE (DPH)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SE 4TH TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3221
Mailing Address - Country:US
Mailing Address - Phone:816-524-4383
Mailing Address - Fax:
Practice Address - Street 1:1011 SE 4TH TER
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3221
Practice Address - Country:US
Practice Address - Phone:816-524-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044593183500000X
KS1-12514183500000X
ARPD11898183500000X
OK15316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist