Individual
RANDALL WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4021 AVENUE B, SCOTTSBLUFF, NE 69361-4602
(308) 630-1919
Mailing address
PO BOX 1886, SCOTTSBLUFF, NE 69361-1886
(308) 630-1919
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
39753
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30773
BLUE CROSS
NE
01
—
P00386100
RAILROAD MEDICARE
NE
Enumeration date
08/10/2006
Last updated
11/16/2007
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