Organization
MOAB FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LEWIS WILLIAMS MD (OWNER/PHYSICIAN/PARTNER)
(435) 259-7121
Entity
Organization
Contact information
Practice address
476 WILLIAMS WAY, A, MOAB, UT 84532-2065
(435) 259-7121
(435) 259-3112
Mailing address
476 WILLIAMS WAY STE A, PO BOX 1270, MOAB, UT 84532-2065
(435) 259-7121
(435) 259-3112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1542
BUSINESS LICENSE
UT
01
—
46D1056014
CLIA
UT
Enumeration date
08/12/2006
Last updated
05/20/2016
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