Organization
TRI-STATE PEDIATRIC ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE P WILLIAMS M.D. (CEO)
(812) 485-6695
Entity
Organization
Contact information
Practice address
3900 WASHINGTON AVE STE 100, EVANSVILLE, IN 47714-0550
(812) 485-7784
(812) 485-4372
Mailing address
PO BOX 5246, EVANSVILLE, IN 47716-5246
(812) 485-7784
(812) 485-4372
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100437790B
—
IN
Enumeration date
05/14/2007
Last updated
06/23/2008
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