Provider Demographics
NPI:1881617306
Name:WILLIAMS, JAMES B II (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1759
Mailing Address - Country:US
Mailing Address - Phone:651-312-1505
Mailing Address - Fax:651-312-1570
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:11
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-312-1620
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32791208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN814795700Medicaid
MN814795700Medicaid
MNE165362Medicare UPIN