Individual
DR. JERRY K WILLIAMS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2301 7TH ST, SUITE B, LAS VEGAS, NM 87701-4966
(505) 426-1200
(505) 426-1202
Mailing address
PO BOX 3861, LAS VEGAS, NM 87701-6861
(505) 426-1200
(505) 426-1202
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
94-167
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM009T07
BCBS
NM
01
—
201047864
PHP & SALUD
NM
01
—
201311184
TAX ID
NM
05
—
23432
—
NM
01
—
C100521093
UNITED AMERICAN
NM
01
—
NM9999
MUTUAL OF OMAHA
NM
Enumeration date
09/22/2006
Last updated
07/09/2007
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